THE  BATTLE  WITH 
TUBERCULOSIS  AND 
HOW  TO  WIN  IT 

ABOOK  FOR  THE  PATIENT 
AND  HIS  FRIENDS     _ 


D.MACDOUGALL  KING, 


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Tubercle  Bacilli  and  White  Cells  (diagrammatic  represtiitatiun  by  the 
author.  See  page  21).  V,  blood-vessel  showing  individual  cells  of  which 
its  wall  is  composed;  C,  white  cells  making  their  way  out  of  blood-vessel; 
li,  tubercle  bacilli;  W,  white  cell  engulfing  tubercle  bacillus. 


thelBATTle  with 

tuberculosis  and 

how  to  win  it^ 

A  BOOK  FOR  THE  PATIENT 
AND  HIS  FRIENDS 


\\ 


/ 


BY 


D.  MACDOUGALL  KING,  M.B 


PHILADELPHIA  AND  LONDON 
J.  B.  LIPPINCOTT  COMPANY 


\AiP3l6 


COPYRIGHT,  I917 
BT  J.  3.  LIPPINCOTT  COMPANY 


EUctrotyped  and  Printed  by  J.  B.  Lippincoit  Company 
At  tht  JVojhington  Square  Press,  Philadelphia,  U.  S.  A. 


GRATEFULLY  AND  AFFECTIONATELY  DEDICATED 

TO  MY  WIFE 

AND 

TO  MY  BROTHER 


"Hasten   then  to  the  end  which   thou 

hast  before  thee,  and,  throwing  away  idle 

hopes,  come  to  thy  own  aid,  if  thou  carest 

at  all  for  thyself,  while  it  is  in  thy  power." 

— Marcus  Aurelius. 


INTRODUCTION 

During  a  sojourn  of  eighteen  months  as  a  patient 
at  sanatoria  in  Canada  and  the  United  States,  and  a 
residence  of  two  years  in  a  health  resort,  the  writer 
has  had  opportunity  to  meet  many  sufferers  from 
tuberculosis  and  to  come  much  nearer  their  secret 
thoughts,  hopes  and  misgivings  than  was  ever  pos- 
sible during  ten  years  of  medical  practice  previous 
to  his  illness.  As  a  result  of  many  conversations, 
not  a  few  confidences,  and  witnessing  the  little 
comedies  and  tragedies  that  ordinarily  are  enacted 
behind  the  scenes  of  sanatorium  life,  he  is  no  longer 
in  doubt  as  to  why  tuberculosis,  which  the  scientist 
knows  tends  kindly  towards  arrest,  is  such  a  fatal 
disease.  He  has  become  increasingly  convinced 
that  the  great  number  of  deaths  occur,  not  because 
the  disease  is  terribly  virulent,  for  in  most  cases  it 
is  not,  but  simply  because  the  majority  of  patients 
do  not  understand,  or  even  begin  to  comprehend, 
the  significance  of  the  reasons  underlying  the  only 
treatment  that  will  bring  success.  And  so  this  little 
book  is  written  in  the  hope  of  setting  forth  in  a 
simple  and  interesting,  but  none  the  less  compre- 
hensive and  convincing  manner,  the  fundamental 
scientific  facts  which  help  to  answer  the  patient's 
constant  inquiry — Why  must  I  do  this  ?  Here  and 
there  similes  and  metaphors  may  seem  extrava- 
gant, but  the  writer  has  sought  by  figure  of  speech 
to  appeal  to  the  patient,  whilst  being  essentially  true 
to  the  scientific  imderstanding  of  the  day. 

5 


6  INTRODUCTION 

It  may  not  be  without  interest  and  encourage- 
ment to  some  readers  of  this  little  book  to  know 
the  writer's  personal  experience  with  tuberculosis. 
The  disease  in  his  case  has  been  of  the  acute  variety 
and  manifested  itself  after  an  attack  of  influenza 
complicated  by  double  pneumonia.  It  spread 
rapidly  to  every  lobe  of  the  lungs,  on  both  the 
right  and  the  left  side  of  the  chest,  and  later  at- 
tacked the  larynx  or  throat.  It  enforced  a  com- 
plete confinement  to  bed  for  over  two  years,  and  at 
times  made  thought  of  recovery  seem  impossible. 
But  now,  just  four  years  since  the  disease  made  its 
appearance,  it  has  become  so  quiescent  as  to  permit 
of  a  limited  amount  of  work,  and  life  would  seem 
to  hold  for  the  writer  the  prospvect  of  years  of  per- 
sonal happiness  and  also  of  service  to  his  fellow- 
sufferers. 

The  author  wishes,  in  conclusion,  to  express  his 
heartfelt  thanks  to  Dr.  G.  Walter  Hoi  den,  Medical 
Superintendent  of  the  Agnes  (Phipps')  Memorial 
Sanatorium,  Denver,  and  to  Dr.  Henry  Sewall, 
Professor  of  Medicine  of  Colorado  University, 
Denver,  not  only  for  their  criticisms  and  sugges- 
tions, but  for  the  professional  guidance  and  advice 
which  have  made  possible  the  writing  of  this  little 
book.  Also,  he  will  ever  remember,  with  grateful 
appreciation,  the  kindness,  encouragement  and  ad- 
vice received  during  the  dark  first  months  of  illness 
from  Dr.  Roderick  Byers,  Medical  Superintendent 
of  the  Laurentian  Sanatorium,  Ste.  Agathe, 
Canada 

Denver,  Colorado,  ^*  "^-  '^ 

July,  1917- 


CONTENTS 


PART  ONE 

CHAPTER  PAGE 

I.  The  Enemy 1 1 

II.  The  Defence  Forces i8 

III.  The  Skirmish  at  the  Outposts 23 

IV.  The  Promise  of  Victory 31 

V.  Reverses 38 

VI.  Days  of  Peace 47 

VII.  Strengthening  the  Home  Forces 55 

VIII.  Strengthening  the  Home  Forces  (Continued) .     62 

IX.  War  Clouds 73 

X.  The  Intelligence  Department 82 

XI.  The  Chief  Medical  Officer 90 

XII.  Choosing  the  Battle  Ground 98 

XIII.  Campaigning  108 

XIV.  The  Orders  for  the  Day 117 

PART  TWO 

XV.  Commandeering  the  Home 127 

XVI.  The  Commissariat 136 

XVII.  The  Beginning  of  the  Battle 145 

XVIII.  The  Fighting  Machine 157 

XIX.  Good  Generalship 167 

XX.  Spe(:ial  Weapons 175 

XXI.  The  Course  of  the  Battle 187 

XXII.  The  Tactics  of  the  Enemy 197 

XXIII.  The  Allies  of  the  Enemy 210 

XXIV.  The  Allies  of  the  Enemy  (Continued) 219 

XXV.  The  End  of  the  Battle 228 

XXVI.  The  Spoils  of  War 238 

Appendix — Disinfectants 248 

Index 255 

7 


ILLUSTRATIONS 

PAGB 

Tubercle  Bacilli  and  White  Cells Frontispiece 

A  Group  of  Sanatorium  Patients 102 

Hallowe'en  at  "The  San" 124 

The  Patient's  Record 148 

A.  Section  of  Normal  Cerebellum 212 

B.  Section  of  Cerebellum   Showing   Effect  of  Extreme 

Emotion.    (Fright) 212 

A.  Section  of  Normal  Liver 214 

B.  Section  of  Liver  Showing  Effect  of  Extreme  Emotion. 

(Fright) 214 


THE  BATTLE 
WITH  TUBERCULOSIS 

PART  ONE 

CHAPTER  I 

The  Enemy 

Of  the  world's  conflicts  there  is  none  comparable 
in  magnitude  or  fatality  to  the  war  between  the 
human  being  and  the  germ.  This  conflict  has  lasted 
for  thousands  of  years ;  every  man  has  been  a  party 
to  it,  and  every  hour  of  every  day  the  battle  is 
still  being  waged.  On  the  one  side  in  this  conflict 
is  the  germ,  a  powerful  enemy  whose  name  is 
legion,  whose  battalions  are  manifold,  and  whose 
methods,  while  entirely  offensive,  are  complicated, 
deceitful,  and  cruel.  On  the  other  side  is  man, 
living,  until  recent  years,  in  blissful  ignorance  of 
the  dangers  that  lurk  by  the  way.  Fortunately 
within  the  citadel  of  his  being  are  forces  of  defence 
as  varied  and  complicated  as  those  of  the  invader ; 
forces  which,  if  treated  fairly,  if  shown  anything 
like  proper  consideration  with  respect  to  rest  and 
food,  will  resist,  with  ingenious  tactics,  the  hourly 
invasion  of  the  enemy's  hosts.  How  many  persons 
there  are  who  realize  too  late  that  through  igno- 
rance they  have  fatally  neglected  their  forces  of 
resistance  and  defence! 

II 


12  THE  BATTLE  WITH  TUBERCULOSIS 

Perhaps  the  enemy's  greatest  advantage  is  that  he 
is  an  invisible  foe.  Lying  in  the  dust,  lurking  in 
food,  smudged  on  fingers  or  sailing  through  the 
air,  he  is  ever  ready  for  the  attack  and  man  is  none 
the  wiser.  The  great  scientist  Pasteur  has  shown 
by  a  very  simple  experiment  that  it  is  difficult  to 
find  any  spot  on  the  earth's  surface  where  germs 
do  not  abound.  He  demonstrated  that  broth  or 
bouillon  turns  sour  simply  because  it  becomes  con- 
taminated by  the  germs  in  the  air,  and  that  it  would 
keep  for  years  just  as  pure  as  the  day  it  was  made, 
provided,  immediately  after  boiling,  it  were  sealed 
in  germ- free  vessels.  In  order  to  prove  that  germs 
existed  in  varying  numbers  in  practically  every 
locality,  Pasteur  prepared  many  little  sealed  vessels 
of  germless  bouillon  and,  taking  them  with  him, 
travelled  through  city  and  town,  into  the  fields  of 
their  suburbs  and  out  to  the  meadows  of  the  coun- 
try. Where  he  wished  to  ascertain  the  presence 
of  germs  in  the  air,  he  opened  for  a  few  moments 
twenty  of  the  sealed  vessels  containing  the  bouillon 
and  then  quite  rapidly  resealed  them.  He  went  on 
into  the  foot-hills  and  mountains,  in  each  locality 
opening  and  sealing  other  twenty  flasks  of  bouillon, 
and  did  not  rest  until  he  finally  ascended  Mont 
Blanc,  and  opened  to  the  mountain  air  twenty  more 
of  his  bouillon  flasks.  Of  the  twenty  flasks  opened 
in  the  city  of  Paris,  practically  all  went  bad;  of 
twenty-three  opened  on  a  country  road,  eight  went 
bad ;  of  another  twenty  opened  in  the  foot-hills  of 
the  mountains,  only  five  went  bad ;  while  out  of  the 
twenty  flasks  opened  on  the  summit  of  Mont  Blanc 
but  one  showed  contamination  by  germs.    It  must 


THE  ENEMY  13 

not  be  imagined,  however,  that  all  of  the  genns 
thus  demonstrated  by  Pasteur  are  enemies  of  the 
human  body ;  indeed,  some  are  friendly ;  some  live 
only  on  dead  things  and  thereby  produce  excellent 
food  for  all  vegetable  life,  while  the  dangerous  ones 
prey  upon  living  beings.  Nevertheless,  the  old 
proverb,  "  Birds  of  a  feather  flock  together,"  holds 
as  true  here  as  elsewhere,  and  you  may  be  sure  that 
localities  which  show  the  greatest  number  of  germs 
which  make  bouillon  turn  sour  are  also  contami- 
nated by  the  greatest  nimiber  of  human  enemies  or 
disease-producing  germs. 

Like  enemies  the  world  over,  germs  become  much 
braver,  much  more  vicious  or  virulent  in  their  at- 
tacks, when  congregated  together  in  large  numbers. 
iWhen  few  and  scattered,  they  become  weak  and 
comparatively  harmless ;  but  allow  weakened  mem- 
bers of  the  force  once  to  join  with  their  friends, 
as,  for  example,  around  a  decayed  tooth,  in  a  very 
short  time  they  regain  their  strength  and  activity 
to  a  surprising  degree.  'Also,  in  regions  where  they 
can  obtain  the  proper  food,  so  rapid  is  their  growth, 
by  a  simple  process  of  dividing  their  bodies  into 
halves,  each  of  which  becomes  a  distinct  organism, 
that  even  in  a  very  few  hours  they  multiply  to  many 
times  their  former  numbers. 

While  in  general  possessing  many  features  alike, 
each  battalion  of  germs,  so  to  speak,  or  group  of 
battalions,  has,  nevertheless,  distinctive  characteris- 
tics in  appearance  and  effect.  Each  has  its  own 
variety  of  ammimition,  which  is  ix>ison  or  toxin, 
and  the  appearance  of  the  man  who  has  fought  and 
lost  the  battle  tells  the  story  of  the  nature  of  the 


14  THE  BATTLE  WITH  TUBERCULOSIS 

conflict  and  makes  possible  a  classification  of  the 
enemy. 

One  might  well  compare  the  virulent  strepto- 
coccus, or  blood-poisoning  germ,  to  cavalry  that 
charges  with  sudden  shock  and  startling  effect ;  or 
one  may  see  in  the  violence,  the  conflagration  and 
the  destruction  of  the  brief  five-to-nine-day  attack 
of  pneumonia  the  work  of  heavy  artillery.  The 
steady  approach  of  infantry  finds  a  parallel  in  the 
three  or  more  weeks'  relentless  advance  of  the  ty- 
phoid germ,  advancing  and  fighting  step  by  step, 
weakening  his  victim;  devastating  all  behind  him 
and  often  returning  to  the  attack  when  apparently 
beaten.  But  if  there  exists  an  army  whose  chief 
purpose  it  is  to  besiege,  every  member  of  the  tuber- 
cle bacillus  host  must  hold  in  such  a  force  a  decora- 
tion for  distinguished  service.  Endowed  with  abil- 
ity to  not  only  hold  his  position  for  years  at  a  time, 
but  on  every  possible  occasion  to  make  telling  and 
dangerous  sorties,  the  tubercle  bacillus,  unrelenting, 
uncompromising  and  indestructible,  must  rank  in 
the  first  line  of  adversaries,  with  a  toll  of  death  as 
constant  as  it  is  imsurpassed.  What  irony  that 
men  should  struggle  to  slay  each  other  while  in 
their  midst  there  stalks  an  enemy,  common  alike  to 
man  and  beast,  ever  working  misery  and  sorrow 
and  dealing  destruction  and  death ! 

It  very  often  happens  that  one  division  of  germs, 
seeming  to  realize  that  it  is  going  to  have  difficulty 
in  winning  the  battle  on  its  own  resources,  calls 
to  its  aid  reinforcements  from  another  division. 
For  example,  the  blood-poisoning  streptococcus, 
having  failed  to  bring  about  complete  ruin  in  its 


THE  ENEMY  J5 

attack,  is  very  often  assisted  to  ultimate  victory  by 
the  pneumonia  division;  or,  again,  the  influenza, 
pneumonia  and  tubercle  germs  may  all  join  forces. 
These  combinations  attacking  the  human  body  are 
called  "  mixed  infections,"  and,  while  there  may  be 
occasion  to  refer  to  them  later,  it  might  at  once  be 
mentioned  that  the  consideration  of  greatest  im- 
portance must  be  the  tubercle  bacillus. 

Like  some  of  the  warriors  of  old,  this  worst  of 
enemies  is  clad  in  a  coat  of  mail  which  is  well  nigh 
impenetrable,  and  it  is  with  considerable  difficulty 
that  the  bacteriologist  is  able  to  stain  him  for  exam- 
ination. It  is  quite  impossible  to  kill  him  by  freez- 
ing; indeed,  he  has  been  found  quite  lively  after 
being  kept  continuously  frozen  for  four  months. 
Twenty-four  hours  m  a  5  per  cent,  solution  of  car- 
bolic acid  does  not  end  his  activity ;  even  boiling  him 
for  five  minutes,  if  he  be  in  a  fair-sized  lump  of 
sputum,  fails  to  annihilate  him.  When  his  body  is 
dyed  a  deep  red  and  placed  under  a  powerful  micro- 
scope which  magnifies  a  thousand  times,  he  looks  like 
a  tiny  clipping  of  red  silk,  about  one-sixteenth  of  an 
inch  in  length.  It  is  because  he  has  this  rod-like 
shape  that  he  is  called  a  bacillus;  if  he  were  round- 
shaped  like  a  period  or  a  dot,  he  would  be  called  a 
coccus.  His  legions  are  divided  into  four  divisions, 
and  it  is  fortunate  indeed  that  all  of  the  divisions 
do  not  attack  man. 

One  division  or  type  of  tubercle  bacillus  at- 
tacks fish  and  snakes  and  cold-blooded  crea- 
tures only;  another  type  is  death  on  birds,  and 
particularly  on  chickens;  fortunately  neither  of 
these  types  attacks  human  beings,  nor  do  the  tubercle 


I6  THE  BATTLE  WITH  TUBERCULOSIS 

germs  that  attack  man  appear  to  molest  the  hot- 
blooded  chicken  or  the  cold-blooded  .snake.  It  is 
not  so,  however,  with  the  "  bovine  type  "  or  the 
tubercle  germ  that  attacks  cattle.  Beef  and  milk 
from  tuberculous  cows  may  cause  tuberculosis  in 
human  beings,  and  particularly  in  little  children. 
Similarly,  the  type  or  division  which  attacks  the 
human  being  may  invade  the  bodies  of  animals. 
Some  animals  are  more  susceptible  of  attack  than 
others.  Thus,  the  pi^  falls  an  easy  prey  to  the 
bovine  enemy ;  but  it  is  very  resistant  to  the  "  human 
type,"  while  it  is  with  difficulty  that  the  cat  or  dog 
is  infected  with  either  type.  But  even  these  latter 
are  sometimes  attacked  by  the  human  germ,  as  was 
demonstrated  by  a  young  lady  tuberculous  patient 
who,  upon  finding  a  piece  of  m«at  difficult  of  masti- 
cation, took  it  from  her  mouth  and  gave  it  to  a  pet 
dog  to  eat,  with  the  result  that  the  dog  soon  de- 
veloped tuberculosis. 

Like  all  good  fighters,  the  tubercle  bacillus  is 
.well  nourished;  he  is  enveloped  with  from  lO  to  40 
per  cent,  of  fat,  and  just  as  the  very  fat  soldier 
is  slow  and  inclined  to  be  lazy,  so  also  the  very 
fat  tubercle  bacillus  is  less  active,  while  the  lean 
fellow  is  deadly  or  very  virulent  in  the  poison  he 
produces.  One  can  readily  imagine  what  an  asset 
his  diminutive  size  is  to  him.  He  and  thousands 
of  his  friends  can  rest  with  perfect  safety  in  one 
of  the  little  grooves  of  your  finger  without  in  any 
way  changing  its  perceptible  cleanliness.  They  can 
ride  in  hundreds  on  the  tiny  fragment  of  dust  which 
one  sees  peacefully  floating  in  the  single  sunbeam 
that  steals  through  a:  hole  in  the  blind.    An  entire 


THE  ENEMY  17 

regiment  of  tubercle  bacilli  can  readily  obtain  trans- 
portation on  the  hairy  foot  of  another  foe,  the 
house-fly.  But  you  must  not  imagine  that  every 
fragment  of  dust  you  see  is  laden  with  tubercle 
bacilli;  in  fact,  you  have  no  right  to  assume  the 
presence  of  these  germs  in  any  place  except  where 
there  has  been  a  careless  or  ignorant  consumptive. 
Wherever  people  congregate,  however,  there  is  un- 
certainty, for  while  the  number  of  deliberately  care- 
less consumptives  is  relatively  small,  the  number  of 
ignorant  tuberculous  individuals  and  people  who  do 
not  even  know  that  they  are  suffering  from  tuber- 
culosis is  very  large.  Thus  it  happens  that  we  are 
surrounded  by  enemies  looking  for  an  entrance  to 
our  bodies,  and  were  it  not  for  opposing  forces, 
every  living  being  would  rapidly  succumb  to  the 
attack. 


CHAPTER  II 
The  Defence  Forces 

Sunlight  is  of  more  importance  than  all  else  in 
preserving  our  lives  against  the  attack  of  the 
tubercle  bacillus.  Day  by  day,  it  is  actively  en- 
gaged in  slaying  millions  of  the  enemy;  indeed, 
could  the  rays  of  the  sun  but  gain  access  to  the 
germs  in  the  interior  of  every  dwelling,  in  the 
depths  of  every  cellar,  in  every  nook  and  cranny  of 
the  world,  all  regiments  of  tubercle  bacilli  would 
speedily  be  annihilated.  Unfortunately,  there  are 
many  populated  places  never  reached  by  the  direct 
rays  of  the  sun,  and  there,  particularly,  we  are  liable 
to  find  the  enemy  lurking. 

Next  in  importance  to  sunlight  in  saving  us 
from  destruction  is  the  splendid  army  of  defence, 
or  "  resistance,"  with  which  every  individual  is 
equipped.  This  army  consists  of  enormous  divi- 
sions of  blood-corpuscles,  antitoxins,  agglutinins, 
opsonins,  lysins,  and  many  other  units.  A  volume 
could  be  filled  with  a  description  of  these  forces 
and  their  tactics,  but  h  will  suffice  to  become 
familiar  with  but  one,  and  that  the  most  important 
of  all,  at  the  same  time  remembering  that  prac- 
tically the  whole  army  of  resistance  is  mobile  and 
travels  in  the  blood  and  lymph  streams,  thus  being 
capable  of  reaching  any  and  every  part  of  the  entire 
body  and  of  concentrating  at  any  point  of  attack. 

In  the  division  of  blood-corpuscles,  or  little  cells 
x8 


THE  DEFENCE  FORCES  19 

which  float  in  the  blood,  is  an  immense  regiment 
of  what  will  be  spoken  of  in  future  as  white  cells. 
These  have  many  other  names,  such  as  leucocytes, 
phagocytes,  etc.,  and  the  regiment  is  divided  into 
many  divisions  of  varying  size  and  appearance.  In 
general  the  white  cell  appears  under  the  microscope 
shaped  like  a  little  disc  about  one-quarter  of  an 
inch  in  its  widest  diameter;  actually,  he  is  only 
one  twenty-five-hundredth  of  an  inch  in  diameter. 
He  is  usually  more  or  less  lop-sided  and  is  con- 
stantly changing  shape.  He  is  like  a  diminutive 
jelly-fish  in  movement  and  transparency. 

Like  his  enemy,  the  germ,  the  white  cell  possesses 
the  remarkable  faculty  of  increasing  his  numerical 
strength  m.any  times  by  dividing  himself  in  two 
should  an  invasion  threaten;  in  fact,  physicians 
are  often  able  to  tell  that  germs  have  entered  the 
blood,  and  that  a  battle  is  in  progress,  by  actually 
counting  the  white  cells,  and  finding  that  there  is 
a  very  largely  increased  number  in  a  given  unit  of 
blood. 

The  white  cell's  method  of  giving  battle  is  to 
stretch  one  end  of  himself  out  in  an  arm-like  proc- 
ess, and  with  this  arm  to  encircle  or  embrace  his 
adversary^  who  is  thus  engulfed  or  swallowed,  and 
later,  provided  he  is  able,  digested  by  the  white  cell. 
Apparently  he  is  very  courageous  in  the  attack, 
for  it  sometimes  happens  that  he  swallows  alive 
such  a  large  number  of  germs  that  the  latter  succeed 
in  poisoning  him.  Should  the  white  cell  be  tired 
and  poorly  nourished,  you  can  readily  understand 
that  he  is  more  likely  to  be  overcome  by  the  poison 
than  if  he  is  in  good  fighting  form. 


30     THE  BATTLE  WITH  TUBERCULOSIS 

Under  the  whole  surface  of  your  body,  whether 
external  or  internal,  under  your  skin,  under  the 
membrane  that  lines  your  mouth,  air  tubes  or 
food  passages,  are  millions,  nay  countless  bil- 
lions, of  minute  trenches  or  lymph-spaces  in 
which  the  white  cell  and  his  allies  are  on 
active  service.  It  would  be  quite  impossible 
for  you  to  prick  yourself  with  the  point  of  a  needle 
anywhere,  outside  or  inside  the  body,  without  en- 
tering one  of  these  minute  trenches  where  the 
white  cell  is  on  the  lookout  for  the  enemy. 

Every  trench  or  lymph-space  is  provided  with  a 
communication  trench,  and  this  great  network  leads 
back  through  well-defined  lines  of  communication 
or  lymphatic  vessels  to  many  groups  of  little  forts 
or  blockhouses  known  as  lymphatic  glands.  These 
glands  protect  every  frontier  of  the  body  and  guard 
every  highway  leading  to  its  vital  centres;  more- 
over, they  are  not  only  the  fortifications  of  the 
white  cells,  but  they  are  for  many  of  the  latter  the 
shelter  that  gives  them  birth. 

Beyond  the  fortifications,  and  leading  towards 
the  body's  more  vital  centres,  are  many  well-de- 
fined roadways  or  vessels,  and  the  white  cell 
wanders  from  his  blockhouse  home  in  through 
these  vessels  to  the  great  high-road  or  thoracic 
duct  which  opens  into  the  blood-stream.  Upon 
reaching  the  blood-stream,  he  is  sent  out  again 
towards  the  surface  of  the  body,  and  is  mobi- 
lized at  any  point  where  trouble  is  brewing. 
Indeed,  as  he  approaches  a  scene  of  disturbance, 
by  insinuating  himself  between  Its  component  cells, 
he  actually  wiggles  through  the  wall  of  the  blood- 


THE  DEFENCE  FORCES  21 

vessel  in  which  he  travels,  and  so  gets  out  into  the 
trenches  or  lymphatic  spaces.  Thus  you  must 
imagine  him  as  continually  doing  outpost  and  sentry 
duty,  marching  up  and  down  every  avenue  in  the 
body  where  the  enemy  is  likely  to  appear,  and 
hurrying  to  assist  his  comrades  wherever  and  when- 
ever a  germ  may  seek  to  make  its  entry. 

Let  us  imagine  that,  through  a  pin  prick,  some 
blood-poisoning  germs  have  managed  to  effect  an 
entrance  under  the  skin  of  your  finger.    You  notice 
in  a  little  while  that  the  finger  appears  red  or 
inflamed ;  this  means  that  the  white  cells  have  dis- 
covered the  invasion  and  have  called  for  help,  with 
the  result  that  the  blood-vessels  in  the  vicinity  have 
dilated  in  order  to  allow  a  much  larger  army  of 
defence  to  reach  the  scene  of  hostilities.    The  white 
cells  mass  in  and  around  the  place  of  the  conflict  in 
such  great  numbers  that  the  communication  trenches 
are  quite  blocked,  so  that  unless  the  germs  happen  to 
be  of  a  particularly  fine  fighting  division,  or  unusu- 
ally virulent,  they  are  absolutely  blocked  at  the  sur- 
face, and  are  finally  thrown  off  in  the  pus  from  the 
little  abscess  that  forms,  the  pus  being  the  bodies  of 
the  white  cells  killed  in  the  conflict.    On  the  other 
hand,  the  germs  by  various  tactics  may  manage  to 
get  through  the  communication  trenches  or  lymph- 
vessels,  and  are  then  held  up  in  the  blockhouse 
glands,  and  you  are  made  quite  aware,  by  the  pain 
and  the  swelling  high  up  in  your  arm-pit,  that  a 
desperate  struggle  has  ensued. 

It  is  but  another  mark  of  the  treachery  of  the 
tubercle  bacillus  that  he  manages  either  by  stealth 
or  deception  to  keep  his  identity  masked  until  he 


22  THE  BATTLE  WITH  TUBERCULOSIS 

has  reached  at  least  as  far  as  the  blockhouse  gland ; 
and  even  when  he  is  at  this  point,  or  deep  in  the 
lungs,  and  a  struggle  for  mastery  takes  place,  you 
are  nearly  always  quite  unaware  that  he  has  even 
effected  an  entrance,  and  hence  you  are  apt  to  leave 
your  army  of  defence  without  generalship  and 
destitute  even  of  ordinary  care.  But  even  suppose 
that  the  tubercle  bacilli  gain  entrance  to  the  block- 
houses in  such  great  numbers  that  they  are  able  to 
overcome  the  plucky  white  cells,  or  suppose  that 
the  white  cells  are  too  exhausted  to  put  up  a  strong 
resistance.    Is  the  battle  lost? 


CHAPTER  III 
The  Skirmish  at  the  Outposts 

For  practical  purposes  only  two  avenues  through 
which  the  enemy  may  gain  access  to  the  human  body 
need  be  considered.  It  is  possible,  of  course,  that 
the  tubercle  bacillus,  like  the  blood-poisoning  germ, 
may  get  in  through  a  cut  in  the  skin,  caused  acci- 
dentally, or  by  such  foolishness  as  tattooing,  or 
scratching  a  pimple;  but  nearly  always  the  first 
portal  is  the  nose  or  the  mouth.  He  may  be 
breathed  in  with  the  dust,  but  the  nose  is  so 
equipped  that  normally  it. arrests  95  per  cent,  of 
the  dust  and  germs  in  the  air  that  passes  through  it. 
You  must  see  that  you  are  not  a  mouth-breather, 
for  your  chances  of  breathing  in  germs  are  thereby 
twenty  times  greater  than  if  you  breathed  through 
a  healthy  nose. 

It  is  doubtful  if  as  many  germs  get  through 
the  air-passages  into  the  lungs  as  is  popularly 
supposed.  If  you  have  ever  opened  the  gullet 
of  a  frog  that  has  been  killed,  and  sprinkled 
on  it  a  few  particles  of  cork  dust,  you  will  have 
seen  how  all  the  particles  slowly  travelled  down  the 
membrane  and  finally  dropped  off.  This,  you  will 
find  upon  careful  examination,  is  owing  to  a  per- 
fect forest  of  little  hair-like  processes  called  cilia 
which  wave  together  like  a  field  of  golden  grain 
bowing  before  a  gentle  breeze.  Softly  but  surely 
the  little  particles  of  dust  axe  wafted  along,  all  in 

23 


24  THE  BATTLE  WITH  TUBERCULOSIS 

the  one  direction.  In  like  manner,  the  larger  tubes 
of  your  air-passages  are  lined  by  forests  of  these 
little  cilia,  and  the  greater  part  of  the  5  per  cent,  of 
dust  and  germs  which  manage  to  escape  through 
your  nose  are  caught  by  the  moisture  on  the  walls 
of  your  air-passages  and  are  slowly  wafted  back  to 
the  mouth  by  the  waving  action  of  the  cilia.  That 
germs  and  dust  do,  nevertheless,  reach  the  lung 
tissue  at  times  is  proved  by  the  small  deposits  of 
coal  dust  found  after  death  in  the  lungs  of  many 
coal  miners,  or  by  the  quantities  of  stone  dust 
found  in  the  lungs  in  a  disease  called  anthricosis, 
common  among  stone-cutters.  Experiments  have 
been  performed  on  animals  which  seem  to  prove 
that  tuberculosis  germs  may  enter  the  lungs  direct 
and  start  up  trouble  in  the  lung  tissue  just  where 
they  alight. 

What  happens  most  frequently  is  that  the 
germ  enemy  gets  in  through  the  wall  of  the  air- 
passages,  enters  the  trenches  of  the  white  cells,  and 
makes  his  way  under  disguise  to  the  blockhouse 
gland.  This  happens  not  only  through  the  walls 
of  the  air  tubes  but  through  the  lining  of  the  back 
of  the  nose,  the  throat  and  the  tonsil,  and  is  very 
^inuch  more  liable  to  occur  when  these  structures 
are  in  an  unhealthy  condition  and  there  are  minute 
cracks  or  breaks  in  the  membrane,  as  is  the  case  in 
a  chronically  inflamed  tonsil. 

In  the  mouths  of  many  individuals,  the  enemy 
that  enters  by  chance  is  greeted  by  a  sort  of  recep- 
tion committee.  In  the  single  recess  of  a  decayed 
tooth,  in  the  minute  gum-abscess  under  an  old-time 
crown,  or  in  the  fissure  near  an  unhealthy  tonsil,  arc 


THE  SKIRMISH  AT  THE  OUTPOSTS  25 

millions  of  germs  other  than  tubercle  bacilli,  creat- 
ing in  the  mouth  an  environment  of  the  most  en- 
couraging nature  to  the  soldiers  of  fortune  who 
come  wandering  in.  The  newcomers  may  chance 
to  be  a  very  small  band  of  weakened  warriors,  but 
a  little  while  in  this  hotbed  of  intrigue  suffices  to 
increase  their  numerical  strength  many  fold,  and  to 
fill  them  with  a  deadly  virulence. 

It  is  an  easy  matter  for  tubercle  germs  to  enter 
the  mouth  from  the  world  without ;  food  itself  may 
be  tuberculous,  or  it  may  be  contaminated  by  dust, 
flies,  or  many  other  agencies ;  but  it  is  the  business 
of  the  food  inspectors  to  control  this  source  of 
danger.  Your  concern  should  be  that  the  food  is 
not  contaminated  after  it  reaches  your  home. 
Many  people  there  are,  especially  those  who  come 
in  contact  with  the  sick,  who  contaminate  food 
while  conveying  it  to  their  mouths  simply  because 
they  regard  it  as  too  much  trouble  to  properly 
cleanse  their  hands  before  partaking  of  a  meal. 

Among  people  of  ordinary  refinement,  it  is  a  prac- 
tice to  place  the  hand  in  front  of  the  mouth  when 
coughing,  and  so  the  hand  is  sometimes  sprayed 
with  fine  globules  of  sputum.  Thus  among  people 
who  are  unaware  that  they  are  the  victims  of 
tuberculosis,  and  where  as  a  consequence  the  proper 
precautions  are  not  taken,  food  may  be  contami- 
nated in  the  preparation.  It  is  well  to  remember 
that  the  germ  in  the  moist  condition,  as  he  is  when 
coughed  on  the  hand,  is  much  more  dangerous 
and  more  virulent  than  when  dried  out  in  the  dust. 

It  is  little  children  who  particularly  need  care; 
their  internal  body  waUs,  especially  the  stomach,  are 


96  THE  BATTLE  WITH  TUBERCULOSIS 

more  easily  penetrated  by  the  enemy  and,  like  them- 
selves, their  forces  of  defence  are  immature. 
Creeping  on  the  floor,  constantly  shoving  their  dirty 
fists  and  all  manner  of  foul  things  into  their 
mouths,  they  surely  must  have  a  special  guardian 
angel  who  watches  over  their  precious  lives  and  pre- 
serves them  from  the  enemies  that  hover  around ! 

In  children  under  fifteen,  it  is  probable  that  the 
tuberculosis  enemy  effects  his  entrance  to  the  battle- 
field by  the  stomach  and  intestines  more  frequently 
than  by  riding  on  the  dust  particle  direct  to  the 
lungs.  Hence  the  milk  and  the  food  supply  of  the 
little  people  must  be  carefully  regulated,  and  all 
cattle  should  be  tested  to  make  sure  that  they  are 
free  of  the  dreaded  disease.  It  must  also  be  seen 
to  that  after  food  comes  to  the  shop  or  the  home  it 
is  not  left  where  house-flies  can  convey  to  it  the 
countless  germs  that  roost  on  the  hairs  of  their  legs, 
and  wallow  in  the  excretions  of  their  bodies. 

But  in  spite  of  everything  you  may  do,  germs 
will  gain  entrance  through  the  mouth  and  nose. 
This  is  no  reason,  however,  why  you  should 
not  endeavor,  in  so  far  as  may  be  possible,  to  limit 
the  number  that  gain  access  to  what  is  really  the 
high-road  to  the  battlefield.  Indeed,  it  is  a  very 
definite  reason  why,  through  avoiding  excesses, 
and  giving  fair  consideration  to  your  general  phy- 
sique, you  should  back  up  your  white  cells  in  the 
battle  they  are  continually  called  upon  to  wage 
against  the  incoming  enemy. 

You  have  now  followed  the  enemy  step  by  step, 
in  through  the  nose  or  mouth,  directly  down  to  the 
lungs,  or  into  some  minute  crack  anywhere  in  the 


THE  SKIRMISH  AT  THE  OUTPOSTS  27 

membrane  that  lines  the  whole  interior  of  the  body. 
You  have  seen  him  in  this  way  gain  access  to  the 
white  cells'  trenches,  pass  by  the  outermost  sentinels 
without  causing  suspicion,  and  finally  gain  entrance 
to  the  blockhouse  gland.  And  now,  in  this  little 
fortress,  is  fought  a  most  important  engagement 
with  the  outposts,  an  engagement  upon  which  de- 
pends the  prestige  of  the  white  cells  and  their  allies, 
and  one  which  determines  whether  or  not  they  re- 
main a  first-rate  power.  The  white  cell  pounces 
upon  his  enemy  and  engulfs  him ;  if  he  is  able  to 
go  further  and  kill  him  by  digesting  him,  he  comes 
forth  from  battle  not  only  victor,  but  a  more  ex- 
perienced and  a  stronger  fighter  than  he  has  ever 
been  before.  Just  as  you  are  made  stronger  by 
vanquishing  an  enemy  or  overcoming  a  temptation, 
so  the  white  cell,  through  his  conquest,  gains 
something  that  he  did  not  have  before,  and  the 
next  time  the  tubercle  bacillus  invades  the  body 
he  finds  the  white  cell  and  his  allies  more  resistant, 
or,  to  use  the  scientific  phrase,  the  individual  has 
"  established  increased  immunity."  Thus  you  see 
there  is  a  lasting  advantage  gained  if  the  battle  at 
the  outposts  is  won.  Unfortunately  it  works  the 
other  way  as  well,  and  if  the  tubercle  bacilli,  after 
being  engulfed  by  the  white  cells,  are  able  to  pro- 
duce a  poison  so  virulent  that  it  kills  the  latter, 
the  story  is  very  different. 

There  are  all  degrees  of  victory  for  the  tubercle 
enemy  in  the  blockhouse  gland.  If  complete,  he 
takes  entire  possession  of  the  fortification  or  a 
series  of  them,  cuts  off  the  various  lines  of  com- 
munication by  blocking  them  with  the  dead  bodies 


s8     THE  BATTLE  WITH  TUBERCULOSIS 

of  the  white  cells,  and  proceeds  to  devastate  the 
interior,  and  even  to  break  down  the  walls  of  the 
gland.  Such  an  unfortunate  result  is  much  more 
liable  to  occur  if,  previous  to  the  attack  of  the 
tubercle  bacillus,  the  gland  has  become  enlarged 
through  the  action  of  the  poison  of  other  germs 
entrenched  in  such  places  as  a  decayed  tooth,  in 
adenoids  at  the  back  of  the  nose,  or  in  the  crypt  of  a 
diseased  tonsil.  The  evidence  of  the  devastation 
is  often  to  be  seen  in  the  swellings  and  scars  about 
the  throat  and  neck  of  many  people  who  have  thus 
been  attacked  during  childhood. 

On  the  other  hand,  victory  may  not  be  fraught 
with  so  many  advantages  to  the  enemy.  The  attack 
may  result  simply  in  a  drawn  battle  with  the  tuber- 
cle bacilli  entrenched  in  the  wall  of  the  blockhouse 
gland,  and  apparently  too  frightened  to  make  a  dis- 
turbance. From  the  appearance  of  the  gland  in 
such  cases  one  would  never  know  the  germs  were 
present.  It  would  almost  seem  as  though  the  germs 
realized  that  every  dog  has  his  day,  and  that  in  years 
to  come  the  day  might  dawn  when,  the  candle 
burned  at  both  ends  just  a  little  too  long,  the  neg- 
lected white  cells  would  become  so  weakened  that 
opportunity  to  increase  their  own  numerical 
strength  would  be  afforded  the  germs,  and  so  en- 
able them  to  come  forth  to  battle  with  greater 
chance  of  victory. 

Once  the  tubercle  enemy,  not  having  been  demol- 
ished by  the  white  cell,  gains  entrance  to  the  block- 
house gland,  to  the  lung,  to  the  kidney,  to  the  bone, 
or  to  any  organ  of  the  body  of  an  individual,  that 
individual,  to  use  the  doctor's  phrase,  has  become 


THE  SKIRMISH  AT  THE  OUTPOSTS  29 

"  infected  with  the  bacillus  tuberculosis."  This 
happens  to  at  least  nine  out  of  every  ten  persons 
with  whom  we  come  in  contact.  In  other  words, 
90  per  cent,  of  people  have  tuberculosis  at  some 
time  in  their  lives,  and  this  is  actually  proved  by 
the  findings  in  many  thousands  of  post-mortems 
performed  on  the  bodies  of  people  who  die  from 
any  and  every  cause.  But  while  nine  out  of  ten 
persons  have  tuberculosis,  only  one  out  of  every 
seven  dies  from  it.  It  would  seem  that  when  84 
per  cent,  of  the  people  infected  make  a  successful 
recovery,  tuberculosis  is  not  such  an  incurable  dis- 
ease as  is  popularly  supposed.  But  why,  it  will  be 
asked,  do  not  the  remaining  16  per  cent,  also  re- 
cover ? 

Unfortunately,  some  people  are  bom  into  the 
world  with  forces  of  defence  that  are  particu- 
larly poor  fighters  when  it  comes  to  a  battle  with 
tubercle  bacilli.  Their  white  cells  and  allied  forces 
are  able  to  resist  with  normal  power  other  divisions 
of  the  enemy,  such  as  germs  of  typhoid  and  blood- 
poisoning  ;  but  while  they  have  Inherited  no  tubercle 
germs  themselves,  they  have  inherited  a  weakness 
in  defending  themselves  from  tubercle  bacilli. 
Again,  to  use  a  medical  phrase,  they  have  "  a  pre- 
disposition to  tuberculosis."  There  are  other  people 
whose  forces  are  terribly  weakened  by  attacks  from 
enemies  other  than  the  tubercle  bacillus,  conse- 
quently this  besieger,  following  in  the  path  of  an 
army  which  has  gone  before,  is  enabled  to  gain  a 
hold  on  his  victim  which  is  often  fatal.  However, 
the  great  majority  of  people  who  die  from  tubercu- 
losis are  vanquished  only  because  their  forces  of 


30     THE  BATTLE  WITH  TUBERCULOSIS 

defence  have  been  impoverished  and  ill-treated  for 
a  long  period  without  interruption,  or  because  the 
germ  enemy  has  held  sway  for  months  or  even 
years  without  their  knowledge.  The  line  of  resist- 
ance may  be  badly  down  at  times,  and  the  enemy 
may  carry  the  outposts  and  become  firmly  en- 
trenched, but  give  the  valiant  white  cell  fighters 
half  a  chance  and  Nature  has  so  endowed  them 
that,  with  proper  rest  and  food,  they  will  arise 
stronger  than  before  and  defeat  this  adversary. 


CHAPTER  IV 

The  Promise  of  Victory 

From  the  time  the  tubercle  bacillus  gains  con- 
trol over  even  a  minute  area  in  the  blockhouse 
gland,  or  in  any  other  part  of  the  body,  in  other 
words,  from  the  moment  infection  occurs,  a  change 
in  the  morale  of  the  white  cells  and  their  allies 
seems  to  take  place.  An  element  of  fear  seems  to 
enter  their  make-up,  so  that,  for  at  least  twenty 
years  to  follow,  a  great  commotion  takes  place  in 
the  army  of  defence  whenever  another  invasion 
of  tubercle  bacilli  occurs  in  the  body  or  even  a 
minute  drop  of  the  poison  of  that  enemy  appears. 
Not  only  do  the  white  cells  become  excited,  but 
there  occur  as  a  result  of  the  disturbance  a  slight 
fever,  an  increased  frequency  of  the  heart-beat,  a 
flushed  face,  and  the  individual  begins  to  feel  just 
a  little  out  of  sorts.  Doctors  make  use  of  this  cir- 
cumstance to  find  out  whether  tubercle  germs  have 
gained  a  successful  entrance  to  your  body.  A 
minute  drop  of  the  poison  of  the  tubercle  bacillus, 
which  is  called  "  tuberculin,"  is  injected  under  the 
skin,  into  the  trenches  of  the  white  cells.  If  no 
tubercle  germs  have  succeeded  in  establishing  them- 
selves in  the  gland,  lung,  or  elsewhere,  nothing 
happens.  But  if  it  recalls  to  the  white  cells  and 
their  allies  a  previous  successful  invasion  by 
tubercle  bacilli,  a  commotion  follows  as  mentioned. 
This,  however,  quickly  subsides.     Such  a  commo- 

31 


32  THE  BATTLE  WITH  TUBERCULOSIS 

tion  is  known  as  "  a  positive  reaction  to  tuberculin," 
and  is  certain  proof  that  the  patient  has  been  in- 
fected by  the  tubercle  germ.  Tuberculin  is  also 
used  in  the  treatment  of  tuberculosis  to  stimulate 
the  white  cells  to  greater  deeds  of  valor,  but  a 
description  of  its  use  in  that  connection  must  be 
left  to  a  later  page. 

It  will  possibly  surprise  you  to  learn  that  not 
only  did  your  first  infection  with  tubercle  germs 
probably  occur  in  childhood,  many  years  before 
you  were  conscious  of  having  tuberculosis,  but  that 
you  have  in  all  probability  been  rei^ifected  with  the 
same  germs  many  times  before  the  final  break  which 
filled  you  with  dismay,  and  made  you  feel  that  you 
were  face  to  face  with  death.  Of  course,  it  is 
possible  that  the  onslaught  may  be  made  by  such 
a  large  number  of  the  enemy,  or  by  such  fine  fight- 
ing or  virulent  tubercle  germs,  that  not  only  are 
the  trenches  carried  and  the  forces  of  the  block- 
house gland  overwhelmed,  but  the  enemy  goes  on 
to  much  more  extensive  invasion.  In  such  a  case 
you  are  very  ill.  It  is  the  rule,  however,  for  these 
•besiegers  to  adopt  a  policy  of  attenuation,  i.e.,  to 
slowly  wear  you  down,  and  watchfully  to  wait, 
knowing  that,  where  they  have  effected  an  entrance, 
reinforcements  of  their  own  ilk  will  be  able  to  fol- 
low even  more  easily  and  establish  a  foothold. 

And  so  the  years  roll  by,  and  you  are  'all  un- 
conscious of  the  fact  that  the  enemy  is  waiting  pa- 
tiently in  the  citadel  of  your  being,  and  that  new 
enemies  are  from  time  to  time  winning  the  skirmish 
at  the  blockhouse  glands.  You  go  gaily  along  the 
joyous  path  of  youth,  arriving  home  from  the  club 
or  from  the  dance  in  the  small  hours  of  the  mom- 


THE  PROMISE  OF  VICTORY  33 

ing,  rising  dog-tired  to  a  hard  day's  work,  coming 
home  to  meals  at  any  and  every  hour,  gobbling 
down  your  food  in  order  that  you  may  look  after 
the  hundred  and  one  irons  you  have  in  the  fire; 
exercising  to  utter  fatigue;  on  one  day,  and  the  next 
not  exercising  at  all.  Is  it  any  wonder  that  slowly 
but  surely  the  day  arrives  when  the  tubercle  enemy 
feels  it  safe  to  venture  from  his  trenches  in  the 
blockhouse  gland,  feels  confident  that  he  can  poison 
the  white  cell  who  endeavors  to  demolish  him,  and 
that  he  increases  his  numerical  strength  and  goes 
boldly  sajiling  in  through  the  lymphatic  high-roads 
into  the  blood-stream  ?  This  is  just  what  he  does, 
and  more. 

Reaching  the  blood-stream,  he  travels  along 
■in  the  current,  until,  as  the  stream  divides  again 
and  again  into  innumerable  branches,  he  becomes 
conscious  that  it  runs  iftore  slowly,  that  the  river  has 
become  but  a  rivulet,  and  that  finally  its  borders 
have  so  narrowed  that  they  are  easy  of  approach. 
Then  he  effects  a  landing,  and  behold,  he  is  ashore 
on  lung  tissue!  It  is  possible  that  he  may  be 
washed  right  through  the  fine  capillaries  in  the 
lung  and  find  himself  landed  in  some  other  tissue 
like  bone  or  kidney.  But  the  lung  is  the  tissue 
he  likes  best,  and  he  generally  leaves  the  others 
to  a  later  sortie  after  he  has  conquered  definite 
areas  in  the  lungs. 

The  history  of  the  adventurous  bacillus  now 
becomes  practically  identical  with  that  of  the  tu- 
bercle* germ  who  has  reached  the  lung  by  floating  in 
on  the  air  current.  In  the  same  way  as  when  he  first 
reached  the  blockhouse  gland,  he  proceeds  to  en- 
trench himself  among  the  cells  of  the  tissue.    The 

8 


34  THE  BATTLE  WITH  TUBERCULOSIS 

white  cells  attack  him  in  great  columns,  but  they 
fall  on  the  brink  of  his  trenches,  overcome  by  the 
terrible  poison,  and  so  the  avenues  of  approach 
become  blocked  by  the  dead  bodies  of  the  little 
heroes,  and  the  lines  of  communication  are  severed. 
Thus  he  is  left  free  to  destroy  the  tissue  in  his 
vicinity  and  to  convert  the  cells  which  compose  it 
into  giant  blocks  for  a  fortification. 

Could  you  now*  look  at  his  camp,  you  would 
recognize  it  as  a  tiny  white  ball  about  as  large  as  the 
head  of  a  pin.  This  little- ball  is  called  "  a  tubercle," 
and  from  it  the  disease,  tuberculosis,  derives  its 
name.  All  is  quiet  and  dead  in  the  interior  of  the 
tubercle,  but  not  so  at  its  periphery  or  outer  edge. 
Here  the  battle  rages  in  all  its  fury,  the  tubercle 
bacillus  doing  his  best  to  enlarge  his  territory,  and 
the  quixotic  white  cell  throwing  himself  at  his 
enemy,  engulfing  him,  and  carrying  him  bodily  out 
into  the  air  spaces.  Here  also  the  allies  crowd 
about,  doing  their  best  to  neutralize  the  poison,  and 
manufacture  ammimition  that  will  outclass  that  of 
the  enemy. 

So  it  is  that,  about  this  time,  a  very  little  tickling 
begins  to  occur  in  your  throat.  The  grim  proces- 
sion of  the  dead,  and  the  perilous  procession  of  the 
living  with  the  dead  have  commenced.  The  bodies 
of  the  valiant  white  cells,  known  as  pus,  and  hold- 
ing even  in  death  the  living  and  active  enemy,  have 
come  from  the  air-spaces  where  they  fell  with  their 
foe,  and  have  been  wafted  along  the  larger  air- 
•passages  by  the  waving  action  of  the  cilia.  Later 
in  the  disease,  when  the  dead  bodies  become  very 
numerous,  they  may  be  recognized  as  pus  in  the 
sputum,  which  contains  also  much  debris  from  the 


THE  PROMISE  OF  VICTORY  35 

ruing  of  the  battle,  as  well  as  mucus  from  the  air- 
passages,  and  saliva  from  the  mouth. 

Keep  this  weird  procession  of  life  and  death 
ever  vividly  in  your  mind  and,  though  it  is  difficult 
to  comprehend,  make  yourself  realize  that  your  own 
sputum  is  no  exception,  that  it  is  as  deadly  to  your 
friends  as  is  the  sputum  of  the  forlorn  consumptive 
of  whom  you  have  been  thinking. 

Dnce  the  tubercle  enemy  leaves  the  scene  of  battle 
and  travels  through  the  different  air-spaces,  it  Is 
not  surprising  that  the  many  currents  of  air  dis- 
tribute him  to  fresh  fields,  and  that  in  a  short  time 
where  formerly  there  were  only  one  or  two  little 
tubercles  there  should  appear  quite  a  colony.  More- 
over, as  the  enemy  beats  back  the  white  cells,  he 
gradually  extends  his  camp  until  it  approaches 
and  coalesces  or  joins  with  the  camp  of  his  fellows. 
Thus  the  lung  territory  is  slowly  but  surely  ceded 
to  the  enemy,  and  could  you  see  it  now,  it  would  no 
longer  show  the  isolated  and  scattered  little  white 
ball  tubercles,  but  very  definite  tuberculous  foci  or 
areas,  yellow  in  appearance,  cheesy  in  consistency, 
and  as  large  as  a  marble,  an  alley,  or  even  an  egg. 

It  is  generally  about  this  time,  should  fortune 
favor  you  with  a  symptom  or  two  sufficient  to  cause 
anxiety,  that  you  consult  your  doctor,  and  if  for- 
tune still  further  favors  you  with  a  careful  doctor, 
he  will  make  you  expose  your  chest  in  its  entirety, 
both  front  and  back,  and  carefully  examine  it. 
By  tapping  with  his  fingers  or  "  percussing,"  as  it 
is  called,  he  finds  a  little  area  which  is  dull,  i.e.,  a 
spot  that  doesn't  sound  hollow  underneath,  like 
the  other  parts  of  the  chest,  where  there  is  good 
lung  tissue.     It  sounds  solid  underneath  because. 


36     THE  BATTLE  WITH  TUBERCULOSIS 

as  we  have  seen,  the  enemy  has  established  his 
fortifications  down  there  and  his  fortifications  are 
soHd.  Again,  the  doctor  listens  with  the  stetho- 
scope and,  all  about  where  the  fighting  is  going  on, 
he  hears  tiny  cracklings,  called  "  rales."  You  see, 
the  white  celKand  their  allies  are  crowding  around 
the  tubercle,  and  this  makes  that  area  more  wet  or 
moist  than  it  otherwise  would  be.  As  this  moisture 
makes  the  air-spaces  sticky,  they  crackle  when  the 
air  comes  into  them  and  forces  their  sticky  walls 
apart.  The  doctor  now  becomes  suspicious  and 
sends  some  of  your  sputum  to  be  examined  by  a 
bacteriologist,  and  when  the  report  comes  back 
that  tubercle  germs  have  been  found,  you  think  you 
are  the  unluckiest  being  that  ever  lived.  But  that  is 
where  you  make  a  mistake.  Rather  should  you 
thank  God  that  the  discovery  has  been  made  in 
time  for  you  to  give  to  your  white  cells  and  their 
allies  the  backing,  which  is  all  they  need,  to  get 
control  of  the  situation. 

If  you  follow  the  proper  treatment,  the  little 
warriors  organize  for  a  fresh  drive  of  a  different 
character.  They  apparently  realize  that  it  is  im- 
possible to  drive  the  enemy  from  his  entrenchments 
and  fortifications  in  the  lung  tissue,  and  so  they 
proceed,  day  after  day,  week  after  week,  and  month 
after  month,  to  build  about  him  a  strong  cordon  of 
fine  fibres,  until  after  months,  or  perhaps  years,  of 
labor,  they  finally  imprison  the  encampment  of  the 
tubercle  bacillus  in  strong  walls  of  genuine  gristle. 
Indeed,  the  white  cells  and  their  allies  often  go 
farther,  and  carry  load  upon  load  of  minute  blocks 
of  calcium  or  stone,  which  they  not  only  dump  in 
upon  the  enemy,  but  with  which  they  encase  him 


THE  PROMISE  OF  VICTORY  37 

in  a  veritable  vault  of  chalk  cement.  Although  the 
enemy  is  so  tough  that  he  is  not  killed  by  the  con- 
finement, he  is,  nevertheless,  as  incapable  of  doing 
harm  as  is  a  prisoner  in  the  Tombs. 

Of  course,  just  as  circumstances  may  arise  that 
make  it  possible  for  a  prisoner  to  escape,  so 
also  the  day  may  come  when,  through  dissipation  of 
your  regained  strength,  or  through  the  invasion  of 
other  enemies,  such  as  the  pneumonia  or  Influenza 
germ,  the  prison  wall  may  be  broken  down,  and  the 
enemy  escape  and  again  establish  a  footing  on 
healthy  soil.  But  this,  in  great  measure,  is  a  matter 
of  your  own  control.  Surely  once  having  learned 
a  lesson  in  the  school  of  bitter  experience,  you  are 
not  likely  to  neglect  your  army  of  defence  a 
second  time! 

As  time  rolls  on,  and  the  walls  of  the  prison  are 
made  dense,  and  still  more  dense,  they  begin  to 
contract,  and  if  the  location  be  favorable  the  enemy 
and  his  encampment  are  literally  squeezed  out  into 
one  of  the  air  tubes  and  from  there  coughed  up 
and  expelled  from  the  body.  So  it  comes  about 
that  many  years  after  you  have  effected  a  cure, 
when  your  life  in  this  good  old  world  comes  to  an 
end,  and  your  body  has  been  turned  over  to  the 
cause  of  science,  it  is  found,  if  your  disease  has 
been  very  extensive,  that  It  is  almost  impossible  to 
cut  through  your  lung  on  account  of  the  masses 
of  scar-gristle  which  are  scattered  here  and  there 
in  a  bed  of  perfectly  healthy  lung  tissue.  Also 
that  the  edge  of  the  knife  is  often  turned  as  it 
strikes  the  chalk  cement  that  years  before  was 
brought  by  your  white  cells  and  their  allies  to 
imprison  their  foe,  the  bacillus  tuberculosis. 


CHAPTER  V 

Reverses 

Up  to  the  present  we  have  considered  only  that 
form  of  tuberculosis  which  steals  into  your  life 
like  a  thief  in  the  night — incipient  tuberculosis,  it 
is  called,  In  its  earliest  stages.  It  makes  its  appear- 
ance so  gradually,  so  insidiously,  that  you  are  in- 
clined to  regard  its  symptoms  as  related  to  laziness 
from  which  you  must  "  buck  up."  There  are  other 
forms  of  the  disease  which  are  more  startling  irt 
their  onset  and  character. 

You  remember  how  the  tubercle  enemy  first  of 
all  gained  control  of  the  blockhouse  gland  but  was 
unable  to  get  farther  for  the  time  being  because  the 
lines  of  communication  leading  into  the  body  were 
blocked,  and  how  he  proceeded  to  devastate  the 
interior  of  the  gland,  and  even  to  break  down  its 
walls.  Now  it  happens  that  these  blockhouse  glands 
are  located  not  only  in  the  neck,  or  under  the 
arm,  where  possibly  at  some  time  you  may  have  seen 
them  inflamed  and  swollen,  but  they  are  situated 
deep  in  the  chest,  in  the  abdomen,  and  in  many  other 
places  as  well.  It  is  therefore  quite  possible  that 
while  there  may  be  no  sign  of  trouble  apparent  to 
you,  deep  down  in  the  chest,  near  the  root  of  the 
lung,  beside  a  big  air  tube,  or  even  beside  a  vein,  the 
tubercle  enemy  may  be  silently  at  work  tearing  down 
the  wall  of  a  greatly  enlarged  blockhouse  gland, 
and  indeed  going  further  and  tearing  down  the 
38 


REVERSES  39 

wall  of  the  air-tube  or  vein  as  well,  because  the 
latter  presses  very  firmly  on  the  gland,  or  is  in  fact 
stuck  to  it.  Finally  a  day  arrives  and  you  are  at 
work  or  play,  just  as  usual,  when  the  enemy  com- 
pletes his  villainous  task  and  the  tuberculous  con- 
tents of  the  invaded  gland  are  emptied  into  the  vein. 
Away  goes  the  great  army  of  germs  scattered 
broadcast  like  autumn  leaves  on  the  four  winds 
of  heaven;  not  only  into  the  lungs  they  go,  but  into 
practically  every  organ  of  the  body.  The  result 
is  "galloping  consumption,"  and  death.  The 
victim  has  not  an  atom  of  a  chance,  so  why  dis- 
cuss it! 

OBut  there  is  another  condition  which  it  is  in- 
teresting and  profitable  to  consider.  It  happens  that 
in  the  lungs  of  very  many  people,  a  silent  battle  is 
fought  between  the  white  cell  and  his  foe,  the  tuber- 
cle bacillus,  in  which,  through  good  fortune,  the 
white  cell  and  his  allies  overcome  the  enemy  and  im- 
prison him  in  a  cordon  of  fine  fibres,  before  his  en- 
campment becomes  any  larger  than  a  marble  or  a 
bean.  Throughout  this  struggle  the  individual  is 
none  the  wiser.  By  lucky  chance,  or  perhaps  from 
design,  he  slackens  dovv^n  the  pace  he  is  travelling, 
and,  happening  to  be  blest  with  good  fighting  white 
cells  or,  as  it  is  called,  with  good  resistance,  the 
slackening  down  process  gives  his  army  of  defence 
just  the  opportunity  it  needs  to  imprison  the  enemy. 
But  as  life  is  one  series  of  ups  and  downs,  the  day 
comes  when  once  again  the  balance  dips  just  a  little 
too  far  in  the  wrong  direction,  or  possibly  some 
other  enemy,  such  as  the  influenza  or  pneumonia 
germ,  invades  the  lungs,  and  the  prison  walls  are 


40  THE  BATTLE  WITH  TUBERCULOSIS 

rudely  broken  so  that  the  tubercle  enemy  escapes 
en  masse  and  scatters  his  army  in  several  lobes, 
perhaps  in  everyone  of  the  five  lobes  of  the  kmgSi 
where,  with  his  friends  of  the  other  germ  divisions, 
he  rapidly  entrenches  himself  and  sets  up  a  con- 
dition known  as  "  acute  tul^erculosis."  This  occurs 
in  about  lo  per  cent,  of  all  tuberculous  cases. 

The  difference  between  acute  and  incipient 
tuberculosis  is  a  difference  only  in  the  degree  of  in- 
volvement and  the  rapidity  of  development.  In 
time,  if  the  patient  survives  the  acute  stage,  both 
varieties  of  the  disease,  if  not  arrested,  pass  on  into 
"  chronic  "  or  slowly  developing  tuberculosis  with 
identical  results.  In  the  acute  form  the  tubercle 
enemy  gets  important  help  from  germs  of  other 
divisions  almost  from  the  very  beginning.  In 
the  incipient  form,  it  is  only  after  the  sputum 
begins  to  come  that  other  enemy  germs  manage  to 
get  in  to  help  the  tubercle  bacillus  and  to  form  what 
is  called  "  a  mixed  infection."  So  it  is  that  prob- 
ably every  one  who  is  bringing  up  tubercular 
sputum  is  battling  against  a  mixed  infection. 
Naturally  this  alliance  among  the  germs  is  much 
more  destructive  to  the  lungs,  and  more  difficult 
for  the  army  of  defence  to  combat,  than  when  the 
tubercle  enemy  is  waging  the  war  alone. 

As  time  goes  on  and  the  disease  progresses,  the 
earliest  encampments  of  the  enemy,  i.e.,  the  oldest 
tubercles,  are  liable  to  become  softened  in  the 
centre,  and  the  white  cells  so  succeed  in  breaking 
down  the  moorings  of  the  tubercle  to  the  tissue 
round  about,  that  bit  by  bit  the  cheesy  material 
which  comprises  it  is  coughed  up,  and  a  hole  or 


REVERSES  41 

"  cavity  '*  is  left  in  the  place  formerly  occupied  by 
the  forces  of  the  enemy.  Sometimes,  instead  of  a 
cavity,  a  great  number  of  very  small  holes  are 
formed,  and  this  is  spoken  of  as  "  honeycombing." 
It'is  quite  probable  that  later  on  the  honeycombed 
area  will  develop  into  a  definite  cavitation. 

What  a  sense  of  fear,  and  what  dark  forebod- 
ings filled  your  mind  when  you  were  first  informed 
that  a  cavity  had  developed  in  your  chest !  and  how 
very  foolish  you  Were  to  be  so  frightened !  Is  it  not 
better  to  have  an  empty  space  in  your  lungs  than 
that  they  should  contain  instead  of  it  an  encamp- 
ment including  millions  and  milHons  of  the  enemy 
ever  pouring  out  a  deadly  poison  ?  Is  not  an  empty 
house  better  than  a  bad  tenant?  It  is  too  late  to 
grieve.  The  time  for  regret  was  when  you  were 
living  contrary  to  the  laws  of  Nature,  and  the  enemy 
was  building  up  his  tubercle.  The  time  has  now 
come  to  rejoice  that  you  have  thrown  out  of  your 
body  some,  at  least,  of  the  deadly  invaders. 

You  can  readily  imderstand  that  while  the  soften- 
ing process  in  the  tubercle  is  going  on,  while  the 
white  cells  are  loosening  the  enemy's  encampment 
from  its  moorings,  there  is  very  much  more  of 
the  poison  stirred  up  in  the  softened  tubercle  than 
would  otherwise  be  the  case.  If,  by  chance,  the  white 
cells  and  their  allies  have  had  sufficient  time  or 
opportunity  to  build  a  strong  wall  around  the 
tubercle  before  the  softening  started,  the  poison 
does  not  cause  much  trouble.  If,  on  the  other 
hand,  the  walling  of  the  diseased  area  is  not  per- 
fect, some  of  the  poison  will  be  sure  to  get  into  the 
blood,  and,  for  the  time  being,  increase  the  severity 


42  THE  BATTLE  WITH  TUBERCULOSIS 

of  the  symptoms  and  perhaps  make  you  feel 
rather  ill.  Thus,  you  see,  it  is  quite  possible  for  a 
process  to  be  going  on  which  will  hasten  your  re- 
covery, but  which  at  the  same  time  may  make  you 
feel  more  ill  than  you  have  felt  since  you  had  the 
disease.  You  can  now  understand  why  very  often 
you  have  to  become  a  good  deal  worse  before  you 
can  become  any  better,  or  why,  after  having  gone 
along  beautifully  a  certain  length  of  time,  you  sud- 
denly, without  any  apparent  rhyme  or  reason,  are 
put  on  your  back  with  fever  which  lasts,  in  some 
instances,  for  months. 

While  softening  is  taking  place,  and  the  dis- 
eased areas  are  breaking  away  from  the  healthy 
tissue,  it  is  not  surprising  that  a  little  bleeding  in, 
the  vicinity  is  likely  to  occur,  especially  if  you  are 
not  keeping  very  quiet  in  bed.  The  bleeding  or 
"  hemorrhage  "  is  most  startling  both  to  yourself 
and  friends,  and  you  are  quite  convinced  that  you 
are  going  to  die.  It  is  perhaps  just  as  well  that 
you  are  somewhat  frightened,  as  you  are  more  likely 
to  do  what  you  are  told  until  the  time  of  danger 
is  over.  Good  friends  will  assure  you  that  a  hemor- 
rhage is  a  fine  thing,  as  they  remember  somebody 
who  started  to  recover  from  the  very  time  he  lost 
some  blood.  There  is,  perhaps,  more  consolation 
than  knowledge  of  fact  in  what  your  friends  say. 
However,  inasmuch  as  a  hemorrhage  very  often 
marks  the  time  of  softening,  and  through  the  soft- 
ening there  is  cleared  out  considerable  of  the 
trouble  which  has  been  keeping  you  ill,  it  will  not 
do  to  be  too  sarcastic  about  the  blessings  conferred 
by  hemorrhages. 


REVERSES  43 

A  hemorrhage  is  practically  always  an  accident, 
and  may  come  at  any  time  in  the  course  of  tubercu- 
losis. It  is  frequently  the  first  conflagration  in  the 
war  that  startles  you  into  a  realization  that  the 
enemy  is  upon  you;  it  occurs  in  60  per  cent,  of  all 
cases.  In  2  per  cent,  of  all  people  with  pulmonary 
tuberculosis,  it  is  the  final  outburst  that  tragically 
brings  eternal  peace  to  the  forces  of  defence. 

After  the  enemy  or  enemies  have  made  definite 
conquests  in  the  lungs,  it  is  not  at  all  unusual  for 
them  to  give  their  attention  to  other  areas.  Being 
so  near  to  the  pleura,  or  tissue  which  covers  the 
lungs,  it  is  natural  that  the  germs  should  invade 
this  structure  early  in  the  disease;  indeed,  they 
sometimes  cause  trouble  there  years  before  any 
tubercular  disease  can  be  discovered  in  the  lungs. 
It  is  for  this  reason  that  the  man  who  has  had 
pleurisy  generally  finds  he  has  difficulty  in  securing 
life  insurance.  The  life  insurance  doctors  have 
learned  to  suspect  the  presence  of  the  tubercle 
enemy  in  a41  such  cases. 

Imagine  the  lung  of  one  side  of  the  body  to  be 
covered  and  held  intact  by  an  ordinary  football. 
The  rubber  nozzle  of  the  ball  would  represent  the 
root  of  the  lung,  or  the  place  where  the  large  air- 
tube  and  blood-vessels  come  off.  If  the  bladder 
of  the  ball  were  continuous  with  its  cover  around 
the  nozzle  or  root,  and  the  bladder  and  the  cover 
were  composed  of  the  same  material,  you  would 
have  a  fair  representation  of  the  pleura  as  it  covers 
the  lung.  The  inner  coat  of  the  pleura,  or  that  part 
of  it  represented  by  the  bladder  of  the  football,  is 
attached  firmly  to  the  lung,  while  the  outer  coat,  or 


44  THE  BATTLE  WITH  TUBERCULOSIS 

that  part  of  the  pleura  represented  by  the  cover 
of  the  football,  Is  attached  to  the  ribs  and  body  wall. 
So  it  is  that  when  air  goes  in  and  out  of  the  lung, 
the  inner  layer  slides  on  the  outer  layer. 

The  pleura  is  normally  very  flexible  and  slippery 
and  the  two  surfaces  glide  over  each  other  with 
graceful  freedom  at  each  movement  of  the  chest 
or  lungs.  But  when  the  enemy  invades  their 
shiny  surfaces,  it  is  not  long  before  the  shininess 
and  the  slipperiness  disappear  and  the  surfaces  be- 
come, at  the  affected  spots,  red  and  rough  and  some- 
times stuck  together.  Is  It  any  wonder  that  a  pain 
like  the  stab  of  a  knife  shoots  through  your  chest  as 
these  inflamed  surfaces  are  pulled  apart  and  rubbed 
the  one  against  the  other  when  you  breathe  or  move 
your  chest?  It  is  interesting  to  note  how,  when  the 
invasion  is  not  a  serious  one,  the  application  of  the 
hot-water  bag  or  mustard  plaster  dilates  the  blood- 
vessels in  the  vicinity  so  that  a  much  greater  army 
of  defence  Is  able  to  rush  to  the  rescue  and  thus  soon 
bring  relief.  Sometimes,  however,  the  Inflamed 
surfaces  stick  together  "  for  keeps,"  and  then  we 
have  what  is  known  as  an  adhesion.  But  adhesions 
are  sometimes  a  very  good  thing,  as  they  keep  the 
lung  in  the  vicinity  much  quieter  than  It  otherwise 
would  be,  and  so  give  to  the  white  cells  and  their 
allies  a  better  opportunity  to  get  In  their  good  work 
of  walllng-off  the  enemy  and  of  thus  healing  the 
lung. 

Like  warriors  the  world  over,  the  tubercle  enemy 
has  two  methods  of  making  expeditions  to  new 
fields  of  action.  He  either  sails  or  he  marches,  and, 
in  fact,  he  often  does  both.    He  may  leave  his  con- 


REVERSES  45 

quered  territory  in  the  lungs  by  taking  to  the  blood 
or  lymph-stream  and  sailing  in  it  to  any  part  of  the 
entire  body.  Or,  as  he  marches  up  the  air-passages, 
if  the  opportunity  presents  itself  he  may  decide  to 
establish  a  new  camp  on  the  vocal  chord  or  wall  of 
the  throat.  Or,  being  swallowed  in  the  sputum,  he 
may  travel  through  the  intestine  and  dig  his  trenches 
at  some  favorable  point  in  that  structure.  No  mat- 
ter where  he  lands,  in  bone,  in  kidney,  in  brain,  or 
joint,  he  begins,  just  as  he  began  in  the  blockhouse 
gland  or  in  the  lung,  and  slowly  builds  his  little 
tubercle.  He  is  the  one  enemy  who  is  unhandi- 
capped  by  vanity.  He  does  no  hurrahing  or  cheer- 
ing; he  resorts  to  no  fireworks,  but  seemingly  real- 
izes the  value  of  the  strictest  censorship.  Without 
attracting  any  but  the  most  casual  attention  and 
comment,  he  silently  and  stealthily  advances  day 
by  day,  week  by  week,  and  month  by  month,  until 
whole  lobes  of  the  lung  are  excavated  and  gone, 
until  structure  after  structure  is  taken  as  a  prize, 
and  until,  after  three  to  five  years,  the  patient 
finally  has  become  so  very  weak,  or  has  so  little 
lung  left,  that  death  presents  the  tubercle  enemy 
with  uncompromised  victory. 

It  is  very  infrequent,  however,  that  the  course 
of  the  battle  leads  directly  towards  recovery,  or 
is  in  favor  of  the  enemy  from  beginning  to  end. 
To  be  sure,  there  are  some  cases  that  in  spite  of 
everything  go  from  bad  to  worse,  and  from  the 
beginning  the  doctor  realizes  the  hopelessness  of 
the  struggle.  But  nearly  always  the  battle  seems 
to  swing  now  one  way,  now  another,  and  it  is  lost 
generally  because  the  white  cells  and  their  allies 


46  THE  BATTLE  WITH  TUBERCULOSIS 

have  not  been  given  a  fair  chance.  At  practically 
no  time  in  its  course  is  the  situation  hopeless.  Ex- 
tensive involvement,  hemorrhages,  cavities,  tuber- 
culous throat,  what  you  will — none  of  them  mean 
utter  defeat.  Not  infrequently,  apparently  hope- 
less cases  progress  to  a  cure.  Many  a  doctor  who 
has  had  extensive  experience  in  treating  tubercu- 
losis knows  what  it  is  to  be  hailed  on  the  street  by 
a  strapping  young  man  who  introduces  himself 
as  the  tuberculous  patient  whom  the  doctor,  a  few 
years  previously,  had  sent  home  to  die. 


CHAPTER  VI 
Days  of  Peace 

To  seek  in  days  of  peace  means  of  averting  the 
possibility  of  war  is  a  principle  as  deserving  of 
consideration  in  the  humble  home  as  in  the  halls  of 
Parliament;  it  should  occupy  a  place  in  the  heart 
of  the  individual  just  as  much  as  in  the  mind  of 
the  nation.  As  with  respect  to  international  war 
there  are  extremists  of  every  kind,  so  as  regards 
the  war  with  the  tubercle  germ  there  are  pacifists 
and  alarmists  of  many  degrees  and  varieties.  There 
is  the  man  who,  metaphorically,  buries  his  head  in 
the  sand  and  sees  no  danger  anywhere ;  there  is  the 
man  who  believes  in  his  own  divine  right  to  go 
through  the  world  without  regard  or  even  respect 
for  the  ordinary  laws  of  nature,  and  there  is  the 
man  who,  when  the  tuberculosis  bomb  actually 
explodes  in  his  own  home,  pooh-poohs  the  fact, 
and  virtually  denies  its  existence.  Regrettable  as  is 
the  attitude  of  those  peace-at-any-price  individuals, 
it  has  at  least  the  one  redeeming  feature,  that  their 
blind  foolishness  reacts  chiefly  on  themselves.  Not 
so,  however,  with  the  ultra-alarmist  whom  the 
doctors  know  as  "  the  phthisiophobist." 

Phthisiophobia  is  a  sad  condition,  for,  if  there 
be  one  thing  that  is  worse  than  tuberculosis,  it  is 
the  everlasting  dread  of  it.  Do  not  imagine  that  the 
phthisiophobist  is  inspired  by  any  concern  for 
humanity.  He  cares  less  than  nothing  about  the  wel- 

47 


48  THE  BATTLE  WITH  TUBERCULOSIS 

fare  or  feelings  of  other  people,  and  so  long  as  he 
himself  is  kept  free  of  the  dreaded  germ,  the  rest  of 
the  world  may  infect  itself  if  it  wants  to.  He  is 
utterly  selfish,  cowardly  to  a  disgusting  degree,  and 
is  responsible  for  much  spread  of  the  disease.  If 
you  would  do  business  with  him  or  get  within  ten 
feet  of  him,  you  must  spit  on  the  street  like  an  ordi- 
nary person.  Should  you  exhibit  anything  resem- 
bling a  pocket  sputum  cup,  he  immediately  classes 
you  as  a  leper  and,  in  the  future,  your  reputation  is 
sealed  with  him  and  his  friends,  who  look  at  you 
with  that  peculiar  blend  of  sadness  and  alarm  which 
gives  you  a  sense  of  unutterable  resentment.  It  is 
largely  on  account  of  the  demoralizing  effect  these 
selfish  alarmists  have  upon  many  tuberculous  indi- 
viduals that  there  is  urgent  need  of  a  general  lavr 
forbidding  anybody  and  everybody  from  spitting 
anywhere  except  in  a  public  or  private  receptacle. 

To-day,  in  nearly  all  towns  and  cities,  you  are 
politely  requested,  by  notices  that  are  often  obscure, 
to  refrain  from  spitting  on  the  sidewalks,  but  in 
crossing  the  street  you  do  well  if  you  pilot  your  way 
without  running  amuck  of  a  fresh  and  disgusting 
mass  of  sputum.  Aside  altogether  from  the  in- 
fected dust  which  later  occurs,  think  of  what  it 
means  to  be  constantly  tracking  this  source  of  ruin 
and  death  into  your  very  home  and  to  the  children 
who  play  on  your  floor.  No  sputum,  whether 
tubercular  or  not  tubercular,  is  without  its  danger. 
If  it  be  merely  saHva,  what  reason  for  expectorat- 
ing? If  it  be  yellow,  it  contains  pus  and  germs 
and  is  dangerous,  disgusting,  and  filthy.  A  meas- 
ure preventing  its  dissemination  on  the  streets  is 


DAYS  OF  PEACE  49 

pro  hono  publico,  if  any  measure  ever  was;  and 
the  liberty  of  the  individual  is  interfered  with  just 
as  little  or  as  much  as  when  he  is  prevented  from 
expelling  his  other  excretions  on  the  public  high- 
ways. Children,  if  properly  rewarded,  might  be 
expected  to  render  useful  service  in  the  enforce- 
ment of  such  a  regulation.  The  child  is  most  easily 
infected  by  germs,  and  would  therefore  profit  most 
by  such  a  law.  A  small  reward  offered  for  convic- 
tions on  breach  of  the  act  would  soon  bring  the 
sputum  danger  under  control.  It  is,  after  all,  only 
a  matter  of  habit,  and  the  habit,  as  it  exists  to-day, 
is  responsible,  in  the  United  States  alone,  for  one 
death  from  tuberculosis  every  three  minutes.  If 
it  were  controlled  by  law,  it  would  soon  become 
the  fashion  for  people  to  carry  their  pocket  sputum 
cup  just  as  to-day  they  carry  a  match-box  or  purse. 
No  longer  would  the  finger  of  scorn  be  pointed  at 
the  man  who  tries  to  safeguard  the  public  health 
by  using  a  sputum  cup,  and  no  longer  would  there 
exist,  against  the  intelligent  and  careful  tuberculous 
individual,  the  discrimination  which  is  as  unfair  as 
it  is  unfortunate. 

It  is  not  the  honest  and  intelligent  patient  who 
is  to  be  feared,  but  that  great  army  of  unfortunates 
who  know  not  that  they  are  diseased,  or  who, 
if  knowing,  fear  the  talk  of  the  phthisiophobist 
more  than  they  do  the  stigma  on  their  immortal 
souls.  By  all  means  go  out  of  your  way  to  en- 
courage the  honest  man  who  is  fighting  his  desperate 
battle  against  the  tubercle  enemy.  Welcome  him 
into  your  home,  and  make  him  feel  that  you  realize 
the  absolute  security  in  his  understanding  and  care. 


50     THE  BATTLE  WITH  TUBERCULOSIS 

But  shun  as  you  would  an  assassin  the  man  or 
woman  who  has  the  disease  and  is  trying  to  "  bluff  " 
the  world;  he  who,  while  pretending  to  wipe  his 
nose,  surreptitiously  spits  into  his  handkerchief,  or 
he  who,  rather  than  that  the  world  should  know, 
brazenly  expectorates  on  the  thoroughfare.  There 
are  no  words  of  condemnation  sufficiently  strong 
for  the  tuberculous  man  or  woman  who  gains 
entrance  to  a  home  and  heart  which  if  knowing 
the  truth  would  extend  no  welcome.  Be  not  fearful 
of  him  who  openly  confesses  he  has  tuberculosis, 
and  who  therefore  probably  takes  the  proper  pre- 
cautions; but  close  your  home  and  your  heart  to 
him  who  is  knowingly  deceitful,  or  who  exhibits 
the  symptoms  of  tuberculosis,  and  has  not  taken 
advantage  of  the  means  at  hand  to  ascertain  the 
cause  of  his  condition. 

Nations  prepare  in  anticipation  of  the  coming 
of  an  enemy ;  but  in  the  war  with  tuberculosis  the 
enemy  is  already  in  our  midst,  unheralded  and 
stalking  unseen  where  often  he  is  least  suspected. 
Thus  your  first  concern  should  be  that  he  is  not 
left  free  to  attack  you  in  your  very  home.  What 
man  has  intended  to  be  his  castle  of  comfort  and 
bulwark  of  defence  often  becomes  the  worst  har- 
binger of  this  deadliest  enemy,  and  the  more  man 
seeks  to  shut  himself  in  from  an  inquisitive  world, 
the  more  may  his  place  of  privacy  become  his  palace 
of  peril.  To  live  at  peace  with  germ  and  man, 
one's  home  and  heart  must  be  open  as  the  day, 
and  the  sunshine  of  heaven  must  be  allowed  to 
fill  both. 

Societies    for    the    prevention    of    tuberculosis 


DAYS  OF  PEACE  5i 

should  know  that  there  is  a  great  field  for  their 
efforts  in  educating  architects  to  a  realization  of 
the  necessity  of  planning  houses  which  will  have 
their  insides  out,  and  you,  also,  should  realize  that 
the  more  you  sojourn  away  from  the  house  or 
enclosure,  and  the  more  you  dwell  under  the  blue 
canopy  of  heaven,  the  safer  you  are  from  the  danger 
of  the  enemy's  attack. 

See  to  it  that  you  do  not  establish  your  home 
in  a  house  which  has  previously  been  inhabited 
without  having  it  thoroughly  disinfected/  It  is 
not  sufficient  to  ascertain  that  no  one  has  suf- 
fered from  tuberculosis  while  living  in  the  house 
to  which  you  are  going  to  move;  that  is  one 
subject  upon  which  it  is  utterly  impossible  to  get 
at  the  truth.  Further,  should  you  be  going  to  board 
in  a  strange  home  for  any  considerable  length  of 
time,  take  measures  beforehand  to  make  absolutely 
certain  that  at  least  your  own  room  is  free  of  the 
enemy.  It  goes  without  saying  that  the  rootm  which 
is  flooded  with  sunlight  is  a  hundred  times  safer 
than  a  room  which  is  not,  for  the  direct  rays  of  the 
sun  will,  in  six  hours,  annihilate  the  tubercle  enemy, 
provided  he  exists  in  a  stratum  no  deeper  than  what 
is  commonly  called  a  smear. 

It  is  not  within  the  means  of  all  to  have  homes 
with  hardwood  floors  and  polished  surfaces,  but 
much  may  be  done  toward  placing  limits  on 
the  abode  of  the  enemy  by  doing  away  with 
carpets,  and  substituting  in  their  stead  painted, 
or  stained  and  varnished  floors,  with  remov- 
able rugs.  By  this  means,  sweeping  may  be  rele- 
asee Appendix,  Disinfection  of  Houses. 


52  THE  BATTLE  WITH  TUBERCULOSIS 

gated  to  the  out-of-doors,  and  the  damp  or  oiled 
mop  take  the  place  of  the  broom  inside  the  house. 
Experiment  has  proved  that  white  enamel  is  the 
least  accommodating  abode  for  the  tubercle  ba- 
cillus; so  in  your  home  preference  may  well  be 
given  to  white  enamelled  furniture  and  wainscoting. 

If  you  are  not  in  a  position  to  afford  what 
is  most  hygienic  for  the  whole  house,  see  to  it,  at 
any  rate,  that  the  nursery,  the  indoor  playground 
of  the  children,  receives  consideration  in  this  re- 
gard. It  should  be  the  sanctum  from  which  the 
stranger  is  barred,  and  the  holy  ground  upon  which 
we  should  not  tread  without  removing  our  shoes  of 
contamination.  The  younger  the  child,  the  more 
easily  it  is  infected,  and  to  put  the  creeping  baby 
down  on  the  ancient  carpet,  or  the  ancestral  rug, 
where  at  frequent  intervals  it  is  sure  to  sample  the 
taste  of  the  particular  brand  of  dust  the  relic  con- 
tains, is  to  court  future  sorrow  and  death.  On 
account  of  the  greater  vulnerability  of  the  child 
special  care  must  be  taken  also  to  guard  it  against 
the  ingestion  of  germs  with  food.  The  mother  or 
nurse  who  cools  her  infant's  pap  by  blowing  on  it, 
or  who  samples  each  spoonful  before  administering 
it,  is  making  a  sad  mistake;  and  the  mother  who 
does  not  inquire  carefully  into  the  character  of  the 
dairy  from  which  comes  the  children's  milk  supply 
is  taking  unnecessary  chances  unless,  of  course,  she 
is  careful  to  pasteurize  ^  the  milk  before  feeding. 
Likewise,  it  is  well  always  to  wash  or  peel  raw 
fruit  before  it  is  eaten. 

Finally,  the  food  in  your  own  home  may  be 

*  See  Appendix,  Pasteurization  of  Milk. 


DAYS  OF  PEACE  53 

contaminated  with  germs  by  a  servant  or  by  any- 
one else  who  is  ill  with  tuberculosis  and  who  does 
not  know  it;  by  flies,  which  are  notorious  germ- 
carriers  ;  and  last,  but  not  least,  by  your  own  dirty 
hands.  See  that  it  is  a  never-to-be-omitted  pro- 
cedure that  you  and  your  household  properly  cleanse 
your  hands  before  in  any  way  handling  food. 

It  is  doubtful  if  the  dangers  from  infection  out- 
side your  house  compare  for  a  moment  with  those 
inside.  A  great  deal  has  been  written  about  the 
danger  of  being  infected  with  tuberculosis  from 
telephone  transmitters,  library  books,  or  while 
travelling  in  sleeping  cars,  but  it  is  questionable 
if  the  menace  is  as  great  as  has  been  supposed.  It 
is  well,  however,  that  telephone  transmitters  should 
be  covered  by  the  little  hygienic  papers  supplied  for 
that  purpose,  or  that  they  should  be  occasionally 
disinfected,  especially  if  strangers  are  in  the  habit 
of  using  the  phone.  Also,  one  should  be  careful  to 
avoid  the  practice  of  wetting  the  finger  on  the 
tongue  while  turning  over  the  leaves  of  a  book ;  and 
it  would  be  well  if  the  authorities  in  charge  of 
sleeping  cars  and  hotels  were  to  see  to  it  that  the 
ends  of  the  blankets  which  come  in  contact  with 
one's  face  were  covered  each  night  before  using 
with  a  few  feet  of  freshly  laundered  cotton — this, 
of  course,  in  addition  to  the  periodical  thorough 
disinfection  that  is  at  present  supposed  to  be  carried 
out. 

The  reports  on  the  presence  of  tuberculosis  dis- 
covered by  means  of  school  medical  inspection  are 
indeed  appalling.  Yet  a  careful  investigation  re- 
veals the  fact  that  the  school  environment  is  less 


54  THE  BATTLE  WITH  TUBERCULOSIS 

responsible  for  this  than  the  home.  To  be  sure,  the 
cases  are  discovered  in  the  school,  but  it  is  generally 
found  that  they  come  from  homes  where  the  enemy 
reigns  supreme.  Of  course,  Johnny  is  very  likely  to 
"  swop  "  gum  with  Jimmie,  and  will  give  his  apple 
core  for  a  toot  on  the  other  fellow's  tin  whistle,  or 
a  tune  on  his  mouth  organ.  Also,  Mary  will  insist 
on  putting  pins  and  money  into  her  mouth,  and 
Jennie  will  spit  on  her  slate  and  sneeze  right  in 
Mary's  face.  But  all  of  these  little  people  must 
be  taught  that,  although  man  has  made  his  mouth 
a  medium  for  curious  and  unhygienic  customs, 
that  aperture,  nevertheless,  is  intended  by  Nature 
as  preeminently  an  opening  into  which  food  and 
drink  should  be  put,  and  that,  while  the  other  fel- 
low's pea-shooter  or  apple  core  is  very  tempting, 
the  cooperative  system  with  regard  to  anything  that 
goes  into  the  mouth  is  the  wrong  basis  on  which 
to  do  business.  But  if  mothers  are  to  worry 
about  all  the  countless  terrible  things  that  may 
happen  to  Johnny  or  Mary,  their  hearts  will  be 
constantly  filled  with  dismay.  Teach  your  children 
wisely  and  carefully  the  dangers  of  life,  and  for  the 
rest  leave  it  to  Him 

"  who   stills   the   raven's   clamorous   nest, 
And  decks  the  lily  fair  in  flowery  pride." 


CHAPTER  VII 
Strengthening  the  Home  Forces 

In  national  politics  it  is  always  a  more  or  less 
perplexing  matter  to  determine  the  degree  of 
strength  to  which  the  army  of  defence  should  be 
raised,  and  the  efficiency  at  which  it  should  be  main' 
tained.  The  issue  is  constantly  obscured  by  differ- 
ing opinions  as  to  the  probability  and  source  of 
attack,  and  by  the  tactics  of  petty  politicians.  Not 
so,  however,  as  respects  the  distribution  of  power 
of  the  human  body.  Here  the  issue  is  clear:  the 
invasion  is  not  only  a  threatened  one,  but  the  enemy 
is  already  in  our  midst,  and  not  only  must  our 
forces  of  defence  be  raised  to  the  greatest  possible 
degree  of  efficiency,  but  we  must  study  carefully 
those  demoralizing  factors  which  tend  to  cause 
degeneration  in  fighting  forces,  both  individual  and 
national. 

Just  as  some  nations  are  weak  from  their  birth, 
so  also  some  races,  and  many  individuals  of  every 
race,  enter  the  battle  of  life  poorly  equipped  for 
conflict.  The  North  American  Indian,  the  negro, 
and  the  aboriginal  races  fall  easy  preys  to  the 
tubercle  bacillus  because,  throughout  the  ages,  they 
have  never  known  tuberculosis,  and  their  armies  of 
defence  have  never  been  trained  in  the  hard 
school  of  experience  to  meet  the  attack  of  this 
deadly  enemy. 

Certain  communities  of  people  have  descendants 
who  are  unequal  to  the  conflict  on  account  of  con- 

55 


56  THE  BATTLE  WITH  TUBERCULOSIS 

sanguineous  marriages  which  have  taken  place  for 
centuries.  This  factor  is  one  which  is  chiefly  re- 
sponsible for  the  excess  of  tuberculosis  on  the  Isle 
of  Man. 

Finally,  many  a  child  is  born  of  parents  who,  not 
only  because  of  tuberculosis,  but  because  of  many 
another  weakness  or  disease,  should  have  forfeited 
the  privilege  of  bringing  children  into  the  world. 
The  law  that  the  sins  and  weaknesses  of  the  fathers 
are  visited  upon  the  children  is  inexorable,  and  its 
recognition  is  not  the  least  important  part  of  obedi- 
ence to  the  Ten  Commandments.  Yes,  many  a 
child  comes  into  the  world  poorly  equipped  for  his 
struggle  against  the  tubercle  bacillus,  but  this  is 
only  a  reason  for  greater  care  in  the  development 
and  maintenance  of  his  army  of  defence. 

It  should  be  realized,  at  the  outset,  that  not  only 
the  younger  the  child,  the  more  easily  is  it  infected, 
but  that  i  f  a  child  can  be  brought  through  its  years  of 
frailty  to  adult  life  without  infection  by  the  tubercle 
germ,  its  army  of  defence  gains  so  tremendously  in 
strength  of  resistance  that  it  becomes  almost  an 
impossibility  for  the  germ  to  effect  a  successful  entry 
into  the  blood.  Nine  out  of  every  ten  people  are 
infected  with  the  tubercle  bacillus  at  least  once  dur- 
ing childhood,  and  although  very  few  of  them  be- 
come aware  of  the  infection,  it  should  be  realized 
that  no  other  factor  so  throws  the  army  of  defence 
open  to  subsequent  successful  attack  by  the  tubercle 
enemy.  No  factor  so  markedly  predisposes  to  sub- 
sequent infections  as  the  existence  of  a  victorious 
tubercle  detachment  already  on  the  ground.  A  first 
infection  paves  the  way  for  a  second,  and  the  second 


STRENGTHENING  THE  HOME  FORCES         57 

makes  it  easier  for  the  third.  With  each  infection, 
the  army  of  defence  is  more  and  more  demorahzed. 
Every  mother  and  father  should  strive  to  prevent 
the  first  infection  In  their  children,  and,  failing- 
that,  to  limit,  as  far  as  they  are  able,  the  number 
of  subsequent  infections. 

There  are  times  in  the  lives  of  all  children  when 
their  armies  of  defence  are  more  open  to  attack 
than  at  others.  Naturally,  when  a  disease  of  any 
kind  occupies  the  resisting  forces,  opportunity  for 
the  tubercle  enemy  to  effect  his  hold  is  more  favor- 
able. There  are  certain  diseases  of  childhood 
which  in  themselves  are  apparently  so  insignificant 
that  many  mothers  are  not  alive  to  the  real  danger 
they  occasion.  With  measles  or  even  whooping- 
cough,  it  is  not  uncommon  to  hear  a  mother  say 
that  as  several  of  her  children  had  been  attacked, 
she  thought  she  might  as  well  let  them  all  "  get  it 
over  with  at  the  one  time."  There  are  probably 
no  diseases  that  open  the  door  more  widely  to  the 
tubercle  germ  than  measles  and  whooping-cough, 
and  it  is  little  short  of  criminal  to  purposely  allow 
any  child  to  become  infected.  In  many  cases  it 
would  pay  in  dollars  and  cents  to  send  the  unin- 
fected children  away  to  board  until  all  danger  is 
passed.  The  only  reason  a  child  has  either  disease 
is  because  he  is  exposed  to  the  infection.  It  is  quite 
unnecessary  for  a  child  to  have  either  disease,  and 
every  child  would  go  through  life  without  either, 
could  he  avoid  exposure  to  its  germ. 

Any  disease  which  inflames  the  lining  membranes 
of  the  throat  or  air-passages,  and  any  disease  which 
enlarges  and  therefore   inflames  the  blockhouse 


58  THE  BATTLE  WITH  TUBERCULOSIS 

glands  makes  it  easier  for  the  tubercle  germ  to  effect 
an  entrance.  Hence,  measles,  whooping-cough, 
scarlatina,  variola,  diphtheria,  and  tonsillitis  should 
all  be  carefully  avoided,  and  once  any  one  of  them 
gains  a  foothold,  the  patient  should  be  allowed  to 
thoroughly  convalesce,  his  white  cells  and  their 
allies  should  be  allowed  to  regain  their  equilibrium, 
before  he  is  exposed  to  the  combination  of  daily 
strain  and  germ  attack  of  ordinary  life. 
•  In  a  previous  chapter  it  was  pointed  out  how 
in  the  normal  healthy  nose  95  per  cent,  of  the  dust 
is  arrested,  and  you  have  seen  how  an  unhealthy 
nose  or  mouth  forms  an  ideal  environment  for  the 
breeding  of  all  kinds  of  germs.  Further,  you  have 
seen  that  these  germs  produce  poisons  which  are 
absorbed,  and  which  keep  the  blockhouse  glands 
continually  enlarged.  See  to  it  then  that  your  child 
has  a  nose  unobstructed  by  adenoids  or  bony  de- 
formities, see  to  it  that  he  does  not  breathe  through 
his  mouth,  and,  finally,  see  to  it  that  his  mouth  is 
free  of  decaying  teeth,  gum  abscesses,  chronically 
inflamed  tonsils,  or  disease  at  the  back  of  the  nose. 
Aside  from  disease,  there  are  critical  periods 
'during  the  life  of  every  individual  when  the  tubercle 
germ  seems  more  disposed  to  manifest  his  presence. 
For  a  child,  the  period  of  puberty;  for  the  woman, 
the  period  of  menstruation,  the  period  immedi- 
ately following  accouchement,  and  also  the  meno- 
pause, or  change  of  life,  are  times  when,  if  trouble 
is  suspected,  the  individual  must  be  guarded  with 
more  than  the  ordinary  care.  But  what  is  meant  by 
more  than  ordinary  care?  As  manifested  by  people 
generaJily,  ordinary  care,  it  would  seem,  is  something 


STRENGTHENING  THE  HOME  FORCES         59 

of  a  negative  quantity,  and,  on  the  whole,  tMids 
to  weaken  the  army  of  defence,  rather  than 
to  build  it  up.  If  you  would  live  more  care- 
fully than  the  ordinary  individual,  if  you  would 
build  up  your  army  of  resistance,  you  must  ex- 
amine into  your  hfe  in  three  directions,  namely, 
as  to  where  you  live,  how  you  live,  and  why  you 
live. 

Important  as  climate  is  in  helping  to  aid  the 
favorable  progress  of  tuberculous  patients  after 
the  disease  has  once  shown  itself,  it  should  be  un- 
derstood that,  no  matter  how  bad,  climate  in  itself 
never  causes  tuberculosis.  Indeed,  a  severe  climate 
often  develops  in  the  individual  a  rugged  resistance 
to  the  tubercle  germ.  An  inclement  climate  is 
unfortunate  just  in  so  far  as  it  drives  people  into 
the  house.  If  one  free  of  tuberculosis  were  prop- 
erly protected,  and  would  remain  out  .of  doors  in 
bad  weather  just  as  in  good  weather,  there  would 
be  no  great  advantage  in  the  latter  over  the  for- 
mer. Of  course,  sunshine  is  an  important  factor 
in  both  the  physical  and  psychological  well-being 
of  anybody.  It  annihilates  the  germ  enemies  which 
lie  in  wait,  and  it  brings  color  to  the  pallid  cheek, 
but  in  the  individual  who  is  free  of  disease,  a 
minimum  of  sunshine  may  be  compensated  for  by  a 
maximum  of  fresh  air.  Dr.  Baldwin,  of  Saranac 
Lake,  says  :^  "  There  seems  nevertheless  to  be  a 
distinctly  protective  influence  in  the  climates  of 
arid  regions,  and  especially  in  elevated  invigorating 
climates,  as  Colorado,  Mexico,  and  the  Alps." 

A  fairly  high  altitude,  whilst  holding  undoubted 
blessings  for  the  tuberculous  patient,  is  not  neces- 

*  Osier's  "Modern  Medicine,"  vol.  iii,  page  144. 


6o  THE  BATTLE  WITH  TUBERCULOSIS 

sary  to  good  resistance  in  a  healthy  individual, 
although  the  man  who  lives  and  works  in  the  moun- 
tains maintains  a  better  degree  of  physical  training 
and  therefore  a  more  efficient  resistance  to  the 
tubercle  enemy. 

More  important  than  climate  or  altitude  is  den- 
sity of  population.  It  is  significant  that  wild 
animals  and  cattle  which  roam  the  plains  are  won- 
derfully free  of  tuberculosis,  and  the  comparison  in 
this  particular  is  striking  between  them  and  the 
domestic  cattle  which  are  "  protected  "  with  sheds 
and  barns.  Some  one  has  rightly  said  that  the  only 
impure  air  in  the  country  districts  is  to  be  found 
in  the  farmers'  houses.  The  out-of-doors  in  the 
coimtry  means  more  to  your  army  of  resistance 
than  any  other  factor  under  the  heading  of  where 
you  live. 

But  everybody  cannot  live  in  the  country,  and 
everybody  cannot  live  out-of-doors.  There  are 
degrees  of  purity  of  air,  and  if  you  cannot  have 
the  best,  you  must  be  content  with  as  high  a  degree 
of  purity  as  is  possible.  It  is  doubtful  if  the  worst 
air  of  the  city  street  is  as  bad  as  the  air  in  your 
home.  It  perhaps  contains  more  smoke  and  dust, 
but,  after  all,  these  are  not  the  worst  evils  of  im- 
pure air.  The  air  of  the  city  street  has  at  least 
the  redeeming  feature  of  being  constantly  on  the 
move,  of  constantly  changing  and  of  supplying 
fresh  volumes  of  oxygen.  Not  so  with  the  air  in 
your  home.  Here,  impurities  are  more  constant 
and  more  concentrated,  and  increase  in  proportion 
to  the  number  of  i>eople  present  and  the  infre- 
quency  with  which  the  air  is  changed. 

It  is  an  easier,  if  not  a  more  comfortable,  matter 


STRENGTHENING  THE  HOME  FORCES  6i 

to  ventilate  in  winter  than  in  summer.  Yet  it  is  in 
winter  that  the  greatest  amount  of  impurity  is  found 
in  the  air  of  your  home,  because  comfort  is  of  more 
immediate  concern  to  you  than  future  health.  There 
is  also  the  economical  side  to  it — you  can't  afford 
to  heat  all  out-of-doors.  One  may  sympathize  with 
both  points  of  view,  but  if  you  don't  care  about 
having  the  window  open  about  one  inch  from  the 
top  and  one  inch  from  the  bottom  in  the  very  cold 
weather,  once  in  the  evening  at  least,  throw  open 
wide  the  windows  and  doors  just  for  a  few 
moments,  not  long  enough  to  chill  the  walls  and 
furniture,  and  then  seal  the  room  up  again  to  your 
heart's  content.  It  will  warm  up  very  quickly,  and 
you  may  sit  in  comfort  in  air  which  is  perhaps  not 
the  bestj  but  at  any  rate  is  not  the  worst.  On  the 
other  hand,  in  your  bedroom,  the  heat  should  be 
turned  off  when  it  is  time  to  get  into  bed,  and  the 
windows  should  be  opened  from  the  top  and  bottom, 
and,  if  need  be,  a  window-sill  board  used  tq  break 
the  draught.  If  it  be  cold  in  bed,  it  is  an  easy  matter 
to  put  on  a  suit  of  underwear,  and  fortify  yourself 
with  a  hot-water  stone  jar.  It  is  better  still  to  sleep 
out-of-doors. 

If  you  are  really  in  earnest  about  getting  fresh  air 
that  will  greatly  help  to  build  up  your  resistance, 
you  cannot  do  better  than  invest  a  dollar  in  Dr.  Car- 
rington's  book,  "Fresh  Air  and  How  to  Use  It."  Or 
write  to  the  National  Association  for  the  Study  and 
Prevention  of  Tuberculosis,  New  York  City,  and 
ask  the  Secretary  to  send  you  the  excellent  litera- 
ture, relating  to  fresh  air  'and  the  prevention  of 
tuberculosis,  which  he  is  always  happy  to  let  you 
have  free  of  charge. 


CHAPTER  VIII 
Strengthening  the  Home  Forces  (Continued) 

In  reflecting  upon  how  you  live,  and  its  bearing 
on  the  efficiency  of  your  army  of  resistance,  occu- 
pation very  naturally  should  be  a  first  consideration. 
Is  your  occupation  one  which  keeps  you  indoors? 
Is  it  dusty  ?  Does  it  expose  you  to  gaseous  fumes  ? 
Does  it  subject  you  to  rapid  changes  of  tempera- 
ture? Is  it  in  unsanitary  quarters?  Does  it 
keep  you  in  a  cramped  position?  Does  it 
force  you  to  keep  irregular  hours?  Does 
it  submit  you  to  overwhelming  temptations? 
And  does  it  supply  money  enough  to  keep  the  wolf 
from  the  door  ? 

The  farmer  and  the  sailor  have  ideal  occupations, 
for  nothing  is  so  conducive  to  fine  resistance  as 
good,  strenuous  work  in  the  vast  and  open  spaces ; 
work  that  makes  you  eat  well,  sleep  well,  and  keeps 
you  happy-hearted.  Any  business  which  keeps  you 
out-of-doors,  and  is  comparatively  free  of  dust  and 
overstrain,  is  good.  Lumbermen,  raftsmen,  garden- 
ers, planters,  policemen,  detectives,  watchmen,  col- 
lectors and  agents  of  all  kinds  should  manage,  so 
far  as  occupation  is  concerned,  to  keep  free  of  the 
tubercle  enemy.  Stone  and  marble  cutters,  quartz- 
workers  and  quarry-men,  on  the  other  hand,  al- 
though they  work  out-of-doors,  are  so  perniciously 
affected  by  the  fine  dust  of  their  trades  that  one  in 
every  two  of  them  dies  of  tuberculosis. 
6« 


STRENGTHENING  THE  HOME  FORCES         63 

Semi-indoor  occupations  are,  naturally,  better 
than  ones  which  are  wholly  indoors.  Of  the  profes- 
sions, clergymen,  doctors  and  lawyers,  and  of  busi- 
nesses, bankers,  brokers,  officials  of  companies, 
hotel  and  boarding-house  keepers,  auctioneers,  mer- 
chants, school  teachers  and  blacksmiths,  show  a 
comparatively  low  death  rate  from  tuberculosis. 
The  classes  of  semi-outdoor  occupations,  excep- 
tions to  the  rule,  which  show  a  greater  mortality  to 
the  ravages  of  the  tubercle  germ,  are  livery-stable 
keepers,  hostlers,  musicians  and  music  teachers. 
It  is  interesting  to  note  that  musicians  who  play  on 
wind  instruments  are  less  frequently  attacked  than 
others  by  the  tubercle  germ,  probably  because  of 
the  additional  development  brought  about  in  the 
respiratory  organs. 

The  workers  who  are  continually  indoors,  and 
amongst  whom  it  is  not  surprising  to  find  many 
deaths  from  tuberculosis,  are  confectioners,  bar- 
bers, compositors,  printers,  pressmen,  servants,  tin- 
smiths, and  leather-makers.  If,  in  addition  to  an 
indoor  occupation,  there  are  certain  kinds  of  dusts 
and  fumes,  the  outlook  is  bad.  One-half  of  the 
deaths  among  cigarmakers  and  plasterers  are  due 
to  the  tubercle  enemy,  and  not  far  behind  in  per- 
centage come  metal  and  glass  grinders  and  polishers, 
woollen  and  cotton  millers,  weavers,  factory  opera- 
tives, men  who  work  in  smelters  and  in  foundries, 
and  chemists.  Here,  again,  must  be  noted  certain 
exceptions.  Statistics  show  that  the  milling  of 
flour  and  grist  is  a  fairly  healthy  occupation,  and 
certain  fumes,  such  as  coal  gas,  sulphurous  acid 
fumes,  and  ammonia  are  really  protective  against 
the  tubercle  bacillus. 


64     THE  BATTLE  WITH  TUBERCULOSIS 

All  occupations  in  which  the  worker  is  brought 
into  intimate  association  with  numbers  of  people, 
such  as  that  of  salesmen  in  shops,  are  naturally  at- 
tended with  greater  risks  of  infection  from  the 
tubercle  bacillus.  Many  undetected  cases  of  tuber- 
culosis become  chronic,  and  masquerade  in  public 
under  the  name  of  grippe,  catarrh,  asthma,  bron- 
chitis, malaria,  etc.,  and  tuberculous  people  of  this 
character  are  the  most  prolific  scatterers  of  the 
dreaded  disease.  They  spread  it  directly  by  cough- 
ing, spitting,  or  shaking  out  their  handkerchiefs, 
and  indirectly  by  contaminating  the  things  they  han- 
dle or  touch  w*ith  germ-infested  clothing. 

The  unfortunate  effect  of  incessant  exposure  to 
extremes  of  temperature  is  to  be  found  in  the 
frequency  of  tuberculosis  among  bakers,  stokers, 
plumbers,  iron  and  steel  workers,  gas  and  steam 
fitters.  In  some  of  these  occupations,  added  to  the 
extreme  of  temperature  is  the  extreme  of  muscular 
strain.  In  the  case  of  draymen,  although  the  occu- 
pation is  out-of-doors,  and  would  therefore  seem 
to  be  a  healthy  one,  owing  to  the  excessive  muscular 
strain  involved,  the  work  is  not  propitious,  so  far 
as  tuberculosis  is  concerned.  The  mortality  from 
tuberculosis  ainong  book-keepers  and  clerks  tells 
the  story  of  the  bad  effects  of  impure  air  and 
cramped  position.  The  high  percentage  of  tuber- 
culosis among  hackmen  bespeaks  exposure  and  ir- 
regular hours.  The  death  rate  from  tuberculosis 
arnong  saloon  and  restaurant  keepers  is  an  indict- 
ment of  foul  air  and  intemperance,  and  the  large 
number  of  consumptives  to  be  found  in  such  open 
air   occupations    as    those    of   the   teamster,    the 


STRENGTHENING  THE  HOME  FORCES         65 

huckster  and  the  peddler  discloses  to  a  pitiable  de- 
gree the  ravages  of  poverty. 

But  you  ask,  what  is  to  be  done?  You  have 
been  trained  to  your  occupation  and  at  this  late 
date  you  cannot  be  expected  to  make  a  change.  By 
no  means  make  a  change  unless  your  health  is  fail- 
ing. Nevertheless  the  strength  to  work  at  anything 
at  all,  it  matters  not  what,  is  better  than  ill-health 
and  inability  to  work  at  the  finest  occupation  known. 
If  you  don't  comprehend  this  now,  it  may  safely 
be  said  that  you  will  realize  it  with  much  bitterness 
when  you  are  on  your  back,  waging  a  life-and-» 
death  struggle  with  the  tubercle  enemy.  If  you  are 
enjoying  good  health,  continue  in  your  occupation, 
but  if  it  leads  along  a  perilous  path,  be  ever  on  the 
alert.  If  your  working  quarters  are  unhygienic, 
never  cease  to  demand  reform.  There  is  one  plank 
at  least  in  the  platform  of  trade  unionists  upon 
which  the  entire  public  is  prepared  to  stand  reso- 
lutely with  labor,  and  that  is  the  demand  for  the 
sanitary  shop.  Much,  however,  depends  on  the 
habits  of  the  worker,  and  your  agitation,  if  it  is 
to  be  effective,  must  influence  the  laborer  as  well 
as  the  capitalist. 

Indoor  positions  should  be  fortified  by  good  ven- 
tilation and  plenty  of  fresh  air,  but  the  danger  of 
dusty  occupations  is  greatly  reduced  by  the  worker 
wearing  a  properly  fitting  respirator.  The  evils  of 
cramped  positions  may  be  reduced  with  proper  exer- 
cise in  the  open  air  during  hours  of  recreation.  Ab- 
solute prohibition  is  the  only  cure  for  the  ill  effects 
of  intemperance;  and  for  occupations  which  de- 
mand severe  muscular  strain,  and  exposure  to  ex- 


66  THE  BATTLE  WITH  TUBERCULOSIS 

tremes  of  temperature,  only  the  strongest  should 
apply.  But  the  dangers  of  occupation  are  generally 
insignificant  in  comparison  with  the  dangers  of  the 
home,  and  the  hours  of  recreation.  You  can,  if  you 
only  will,  make  of  your  home-life  and  your  hours 
of  recreation  not  alone  a  bulwark  of  defence,  but  a 
source  of  strength  that  will  enable  you  to  throw  off 
the  enemy  which  assails  you  in  your  work. 

It  is  a  fact  frequently  remarked  upon  by  people 
of  foreign  countries,  and,  indeed,  avowed  with 
'pride  by  many  Americans  themselves,  that  the  peo- 
ple of  the  United  States  are  greater  "  hustlers  " 
than  the  people  of  any  other  country.  This  is 
true,  but  it  is  doubtful  whether  anything  more  is 
accomplished  by  the  so-called  "  hustling."  Cer- 
tainly this  incessant  rush  is  to  be  credited  with 
many  a  death  from  tuberculosis,  and  is  it  not,  after 
all,  as  Professor  William  James  has  pointed  out, 
a  bad  habit  resulting  from  a  wrong  ideal  ?  ^  Has  it 
not  become  "  the  thing  "  in  the  United  States  for 
men  and  women  to  be  so  terribly  busy  with  work  or 
with  social  engagements,  which  in  the  case  of  many 
women  amounts  to  the  same  thing,  that  they  have 
positively  not  the  time  to  live  healthily?  If  regu- 
larity, system,  and  hygienic  living  do  not  invariably 
bring  a  larger  return  in  dollars  and  cents,  they  at 
least  bring  more  joy  into  life  and  less  sorrow  and 
ruin  from  tuberculosis. 

Regularity  must  be  the  watchword  of  the  healthy 
home.  There  should  be  a  regular  hour  for  each 
meal;  as  regular  an  hour  for  rising  as  for  retiring; 

*"  Talks  to  Teachers  on  Psychology  and  Life's  Ideals," 
Professor  William  James,  page  212. 


STRENGTHENING  THE  HOME  FORCES         67 

a  regular  time,  preferably  one  hour  before  meals, 
for  drinking  a  glass  of  water;  a  regular  hour,  pref- 
erably immediately  after  breakfast,  for  a  bowel 
evacuation;  a  regular  time  for  cleansing  the  body, 
and  especially  the  teeth;  regular  hours  for  work, 
even  if  that  work  is  a  matter  of  attending  social 
functions ;  and  last,  but  by  no  means  least,  regular 
hours  for  play  and  exercise.  Every  healthy  man 
or  woman  should  walk  at  least  four  miles  a  day. 

System  is  carrying  out  the  premeditated  or  un- 
expected programme  of  the  day  in  such  a  way  as 
to  fit  in  with  regular  hours  and  habits.  He  who 
would  be  systematic  is  destined  to  many  failures. 
We  cannot  become  machines,  and  things  will  con- 
stantly arise  to  interfere  with  our  most  carefully 
arranged  plans.  But  much  can  be  accomplished 
and  much  weariness  of  indecision  avoided  if  we 
would  take  ten  minutes  of  every  evening  to  system- 
atically plan  the  activities  of  the  day  to  follow. 
Emergencies  will  arise  which  will  interfere  with 
the  programme,  but  if  a  definite  time  is  prearranged 
during  which  the  majority  of  emergencies  may  be 
met,  one  will  accomplish  a  vast  amount  by  giving 
to  his  body,  and  to  his  army  of  defence,  the  con- 
sideration that  is  their  due. 

If  your  occupation  requires  you  to  remain  in- 
doors most  of  the  day,  it  is  an  easy  matter  to  ar- 
range that  the  one-third  of  the  twenty- four  hours 
which  you  spend  in  bed  shall  be  lived  in  the  open  air. 
Don't  wait  until  you  get  tuberculosis  to  sleep  on  a 
sleeping-porch.  Do  it  now.  Infants,  children, 
adults  and  old  people,  if  properly  dressed,  with 
night-caps,  underclothes,  and  bed-socks,  sleep  out- 


66  THE  BATTLE  WITH  TUBERCULOSIS 

of-doors  on  zero  nights  with  the  gpreatest  comfort 
and  benefit.  One  to  a  bed  should  be  the  rule  where 
health  is  a  first  consideration. 

With  nature,  at  nearly  every  turn,  there  is  what 
may  be  called  an  equilibrium  or  balance,  the  finding 
and  maintaining  of  which  spells  success.  But  it 
varies  with  the  individual,  and  so  each  man  must 
persistently  experiment  until  he  finds  it  for  him- 
self, and  all  fathers  and  mothers  should  endeavor 
to  have  their  children  attain  it  as  nearly  as  possible. 
If  you  were  to  put  your  arm  in  a  sling  and  keep  it 
there,  it  would  in  time  become  wasted  and  useless. 
On  the  other  hand,  it  is  quite  possible  to  exercise 
your  arm  so  violently  that  the  muscular  action 
would  break  the  bone.  Somewhere  between  these 
extremes  is  a  balance  betwen  rest  and  exercise 
which  will  develop  the  arm  to  an  ideal  strength  for 
the  accomplishment  of  work.  You  can  readily  un- 
derstand that  such  a  balance  cannot  be  standardized 
for  all  people,  and  further  you  can  realize  that  for 
any  one  person  it  must  be  more  or  less  of  a  sliding 
scale.  As  you  exercise  and  the  arm  develops,  more 
exercise  may  be  added,  i.e.,  the  balance  will  attain 
a  higher  level  than  before,  until  finally  the  ideal  is 
reached.  Likewise,  there  are  balances  of  work  and 
play,  sleep  and  activity,  pleasure  and  pain,  and 
many  others.  The  balance  of  attack  and  resistance 
is  most  interesting  in  its  relation  to  immunity.  As 
pointed  out,  the  North  American  Indian  and  abo- 
riginal races  succumb  readily  to  tuberculosis  be- 
cause their  white  cells  throughout  the  centuries 
have  not  gained  the  strength  that  comes  with 
struggle  against  the  tubercle  foe.    In  the  same  way 


STRENGTHENING  THE  HOME  FORCES         69 

If,  after  living  in  a  secluded  paradise  free  of  all 
temptation,  you  were  to  be  suddenly  forced  to  en- 
counter the  vices  of  the  world,  there  is  little  doubt 
that  you  would  succumb  to  what,  in  the  case  of  an- 
other, might  be  easily  resisted.  Thus  there  is  for 
you,  or  your  child,  a  sphere  where,  quite  possibly, 
temptation  of  an  extreme  nature  would  be  over- 
whelming, but  where  the  overcoming  of  the  lesser 
temptations  and  obstacles,  which  every  man  sooner 
or  later  is  called  upon  to  meet,  steadily  develops 
moral  resistance.  j 

There  is,  particularly  in  mothers,  too  great  a 
tendency  to  protect  their  children  from  anything 
and  everything  that  is  disagreeable,  or  even  re- 
motely threatening  to  the  child.  We  find  mothers 
sending  their  children  to  school  in  automobiles  be- 
cause the  child  feels  disinclined  to  walk,  allowing 
them  to  play  indoors  because  the  weather  is  threat- 
ening or  because  the  child  is  lonely,  giving  them 
delldacles  because  the  child  refuses  to  eat  what  is 
plain  and  nourishing,  protecting  them  from  the  bad 
little  boy  next  door  because  he  might  tempt  them 
into  mischief — in  short,  responding  to  the  natural 
human  impulse  to  give  the  child  what  he  wants, 
but  not  having  that  impulse  ruled  by  reason.  And 
all  of  this  is  called  carefulness ! 

If  you  would  bring  up  your  child  to  meet  the  dan- 
gers of  life,  do  not  let  the  precious  days  for  develop- 
ing in  him  moral  resistance  and  physical  strength 
■slip  by.  By  all  means  keep  ever  the  watchful  eye, 
but  curb  your  desire  to  interfere  when  the  little 
tragedies  of  childhood  arise.  Learn  to  regard  the 
obstacles  and  rough  spots  on  the  road  of  life  as 


70  THE  BATTLE  WITH  TUBERCULOSIS 

nature's  tonic  for  developing  in  your  child  a  rugged 
self-reliance,  self-control,  and  resistance  to  the 
forces  of  evil  which  assail  the  moral,  mental,  and 
physical  equipment  of  every  individual. 

This  brings  us  to  the  final  question — Why  do 
you  live?  What  is  your  life's  objective?  Is  it! 
one  vain  search  for  pleasure,  or  are  you  seeking 
something  higher  and  nobler?  Here  is  a  young 
man  who  wonders  what  his  chances  are  of  contract- 
ing tuberculosis.  Let  him  tell  how  he  spends  his 
evenings,  and  the  answer  will  not  be  far  distant. 
Love  of  liquor,  love  of  excitement,  love  of  what 
is  sordid,  and  slavery  to  passion  and  pleasure — 
these  are  the  loves  that  break  down  the  finest  army 
of  resistance  that  ever  held  subdued  a  tubercle  foe. 
The  history  of  the  tuberculous  patient  in  the  mar 
jority  of  cases  points  to  the  fact  that  he  has  not 
been  able  "  to  abstain  from,  and  to  enjoy,  those 
things  which  many  are  too  weak  to  abstain  from 
and  cannot  enjoy  without  excess." 

The  prevalence  of  tuberculosis  is  less  marked 
among  married  people  than  among  those  who  are 
not  married,  and  this  is,  as  Mayo  Smith  says, 
"  partly  due  to  the  fact  that  marriage  in  itself  is 
more  or  less  a  process  of  natural  selection,  and 
partly  to  the  greater  regularity  and  soberness  of 
life  induced  by  marriage." 

Be  ever  on  the  alert  to  make  use  of  anything  and 
everything  in  life  which  will  create  a  greater  de- 
gree of  self-control  and  unselfishness.  Something 
accomplished  in  this  direction  may  some  day  save 
your  life,  when  everything  may  depend  on  your 
ability  to  master  your  own  desires  and  to  follow  the 


STRENGTHENING  THE  HOME  FORCES  71 

advice  of  another.  The  training  of  the  day  tends 
too  strongly  towards  achievement,  and  neglects 
renunciation,  and  so,  as  Professor  William  James 
puts  it,  "  Keep  the  faculty  of  effort  alive  in  you 
by  a  little  gratuitous  exercise  every  day.  Be 
systematically  heroic  in  little  unnecessary  points." 

There  exists  with  some  people,  particularly  with 
some  women,  an  unfortunate  fallacy  with  respect  to 
"  unselfishness,"  but  which,  viewed  in  its  true  light, 
appears  quite  the  reverse.  The  individual  is  ob- 
sessed with  the  idea  that  her  life  must  be  sacrificed 
for  those  around  her.  For  who  else  is  there  to  do 
what  has  to  be  done !  The  importance  of  her  activ- 
ities occupies  in  the  mind  of  such  an  one  a  magni- 
tude quite  out  of  proportion  to  their  actual  value. 
Should  anyone  suggest  that  she  should  lie  down 
during  part  of  the  afternoon  for  a  rest,  she  resents 
it  as  tmfair  and  unappreciative — as  if  she,  of  all 
people,  could  possibly  take  the  time  to  rest !  And 
the  declaration  is  followed  by  a  deeply-drawn  sigh. 
The  fact  is  that  her  long-standing  habit  of  being 
busy  would  render  it  intolerable  to  her  to  indulge  in 
any  relaxing  or  reflective  practices.  She  regards 
herself  as  a  martyr  to  an  irremediable  cause.  The 
idea  is  encouraged  by  the  sympathy  of  others,  land 
she  never  stops  to  really  seriously  consider  whither 
her  sacrifice  leads.  Occasionally  the  picture  of  her- 
self as  broken  in  health  flashes  before  her,  but  she 
sees  it  as  something  meriting  sympathy,  rather  than 
as  a  warning  of  expense  and  sorrow  to  others  which 
will  far  outweigh  the  attainments  of  a  life  of  blind 
sacrifice. 

Every  one  should  realize  that  one's  first  and 


72  THE  BATTLE  WITH  TUBERCULOSIS 

binding  duty  is  obedience  to  the  laws  of  Nature. 
If  these  be  broken,  a  punishment  inexorably  fol- 
lows, and  the  sad  part  of  it  is  that  the  punishment 
is  not  confined  to  the  offender,  but  extends  also  to 
relatives,  friends  and  descendants.  No  wish  or 
desire  of  the  heart,  no  kindly  impulse,  should  have 
the  right  of  way  over  the  laws  of  Nature,  It  mat- 
ters not  why  you  break  the  law,  the  punishment  is 
the  same.  If  the  requirements  of  your  home  are 
such  that  to  carry  them  out  you  must  break  the 
laws  of  Nature,  those  requirements  should  be 
changed.  None  of  us  are  indispyensable ;  the  world 
and  the  home  can  manage  without  us,  and  so, 
whatever  else  forms  our  life's  objective,  the  first 
tenet  must  be  obedience  to  reason  and  not  to  im- 
pulse, obedience  to  God  and  not  to  man. 


CHAPTER  IX 
War  Clouds 

It  is  a  lamentable  fact  that  the  battle  between  the 
tubercle  germ  and  your  forces  of  defence  may  have 
assumed  appalling  proportions  before  you  even  be- 
come suspicious  that  the  enemy  is  upon  you.  A 
great  deal  depends  on  your  temperament,  as  to 
whether  or  not  you  become  aware  early  that  there 
is  something  going  wrong  somewhere  in  your  make- 
up. If  you  are  a  man  who  works  hard,  and  are  not 
much  given  to  thinking  about  yourself,  you  are 
likely  to  be  conscious  only  of  your  inability  to  ac- 
complish, in  the  same  time,  as  much  work  as  you 
formerly  did.  Your  staying  powers  have  become 
somewhat  limited ;  you  start  off  just  as  fine  as  ever 
in  the  morning,  but,  as  the  day  develops,  you  find 
yourself  putting  off  things  until  to-morrow  that  you 
used  to  do  to-day;  towards  evening  you  are  just  a 
little  bewildered,  you  don't  think  as  quickly,  as 
clearly,  or  as  accurately  as  you  did  in  the  morning, 
and  you  come  home  from  work  disinclined  to  take 
up  anything  that  requires  concentration  and  effort, 
but  wish  simply  to  loll  around  until  the  hour  for 
going  to  bed  arrives.  Perhaps  also  you  wonder  why 
little  things  irritate  and  worry  you  in  a  way  quite 
out  of  proportion  to  the  usual.  You  may  rightly 
come  to  the  conclusion  that  you  need  a  holiday, 
and  perhaps,  being  able  to  afford  it,  you  take  a  brief 
vacation  and  you  feel  much  more  energetic  for  a 
short  while  after  you  return  to  work.    But  grad- 

73 


74  THE  BATTLE  WITH  TUBERCULOSIS 

ually  the  old  inertia  returns  and  your  friends  say 
you  are  looking  tired.  Should  you  happen  by 
chance,  perhaps  "  just  for  fun,"  to  stand  on  a  pair 
of  scales,  you  note  that  you  are  not  quite  as  heavy 
as  you  were  a  year  ago — oh,  just  a  matter  of  five 
or  ten  pounds  or  so — but,  of  course,  that  is  natural 
enough,  because,  when  you  come  to  think  of  it, 
you  haven't  been  eating  quite  as  much — you  have 
rather  turned  against  your  food  of  late,  and,  in 
fact,  food  is  often  inclined  to  nauseate  you  a  little, 
and  you  think  perhaps  you  will  pick  up  something 
in  the  way  of  a  tonic  at  the  drug  store. 

Haven't  you  a  cough  ?  Well,  no,  nothing  more 
than  the  other  fellow  has,  just  a  clearing  of  the 
throat,  and  that  is,  you  are  sure,  owing  to  a  little 
catarrh  at  the  back  of  the  nose.  And  then  one 
morning,  as  you  are  walking  to  work,  you  suddenly 
feel  something  warm  in  your  mouth,  and  when  you 
spit,  you  are  startled  to  find  that  about  a  table- 
spoonful  of  blood  has  come  up  from  some  place, 
but  you  don't  know  exactly  from  where.  However, 
you  have  heard  of  a  man  who  had  somewhat  the 
same  sort  of  thing  happen  to  him  from  a  "  varicose 
vein  in  the  throat,"  so  perhaps  it  is  wiser  not  to 
frighten  the  people  at  home  by  saying  anything 
about  it.  Your  relatives  have  already  been  talking 
about  your  being  "  run  down  from  overwork." 
Unfortunately,  neither  they  nor  you  realize  that  a 
man  is  practically  never  run  down  from  overwork 
alone;  nearly  always  there  is  a  very  definite  reason, 
other  than  overwork,  and  very  often  a  diseased 
condition  to  account  for  it. 

If    anyone    were    to    suggest    tuberculosis    to 


WAR  CLOUDS  75 

you,  you  would  like  to  hit  him.  The  idea  that 
anyone  in  your  family  could  have  tuberculosis 
is  positively  insulting.  But  as  the  weary  weeks  drag 
into  months,  and  occasionally  you  feel  a  little  fever- 
ish in  the  evenings,  and  the  catarrh  becomes  a 
severe  cough  in  the  mornings,  and  you  disseminate 
in  the  highways  and  byways,  to  say  nothing  of 
your  own  home,  enough  tubercle  germs  to  infect 
the  town,  you  begin  to  have  a  secret  dread  that 
even  you  may  perhaps  have  just  a  little  trouble — ' 
perhaps  bronchitis,  or  "  lung  catarrh,"  but  oh,  no! 
not  tuberculosis!  And  then  you  make  the  most 
inexcusable  mistake  you  ever  made  in  your  life — 
you  refuse  to  go  and  see  a  doctor,  for  fear  of 
what  he  may  tell  you !  The  day  comes  finally  when 
you  literally  fall  in  your  tracks,  a  doctor  is  sent 
for,  and  you  discover  to  your  utter  surprise  that  you 
haven't  six  months  of  life  left,  and  that  other  mem- 
bers of  the  family  are  in  a  fair  way  to  follow  in 
your  footsteps. 

Some  readers  of  this  tragedy  may  feel  that  it 
is  overdrawn,  may  feel  that  it  is  quite  impossible 
for  a  man  or  woman  to  be  so  utterly  ill  with  tuber- 
culosis and  not  know  it.  Within  a  month  of  this 
writing,  there  died  at  a  well-known  sanatorium  a 
young  lady  who,  less  than  three  months  previously, 
had  started  on  a  journey  to  visit  an  exposition. 
She  became  111  on  the  way,  and  not  only  was  it  a 
great  surprise  to  her  to  learn  that  she  had  tubercu- 
losis, but  it  was  found  at  that  time  that  the  enemy 
had  made  such  desperate  ravages  in  her  chest,  ears, 
throat,  and  bowels  that  recovery  was  out  of  the 
question. 


76  THE  BATTLE  WITH  TUBERCULOSIS 

It  was  the  writer's  experience  several  years  ago 
to  witness  an  Indian  wedding  in  the  wilds  of 
Northern  Canada.  The  young  groom  was  a  fine, 
big,  strong,  healthy  looking  fellow,  but  it  was 
noticed  that  during  the  ceremony  his  voice 
was  somewhat  husky.  In  response  to  an  in- 
quiry he  stated  that  the  hoarseness  had  ex- 
isted for  several  months;  his  temperature  was 
taken,  and  it  was  foimd  to  be  over  103°.  The 
reason  may  be  readily  inferred,  still  it  was  quite 
impossible  to  convince  him  that  he  was  ill ;  he  felt 
well  and  there  was  an  end  to  it.  As  you  may 
possibly  argue  that  there  were  extenuating  circum- 
stances to  account  for  the  high  temperature,  it  is 
well  that  you  should  realize  that  no  excitement,  not 
even  a  wedding  ceremony,  is  capable  of  producing 
a  temperature  of  over  99°  in  a  healthy  person. 
Further,  the  temperature  in  tuberculosis  is  so  un- 
stable that  very  little  in  the  way  of  excitement  soon 
affects  it.  It  is  not  at  all  uncommon  for  a  tuber- 
cular temperature  to  be  running  over  the  hundred 
mark  every  afternoon  and  for  the  individual  to  be 
none  the  wiser.  But  a  little  temperature,  say  only 
99°,  repeated  every  afternoon  or  evening,  should 
arouse  your  suspicions,  and  if,  after  resting  for  a 
few  days,  the  temperature  reappears  on  exercise, 
lose  no  time  in  seeking  expert  advice.  If,  with  the 
temperature,  there  is  an  inclination  to  perspire,  even 
a  very  little,  after  going  to  bed  for  the  night,  all  the 
more  reason  for  being  on  your  guard. 

In  the  Indian  bridegroom  a  symptom  which 
should  early  have  aroused  his  anxiety  was  the  per- 
sistent huskiness  of  his  voice.    You  have  doubtless 


WAR  CLOUDS  77 

experienced  a  temporary  hoarseness  upon  "  catch- 
ing cold  "  or  perhaps  from  undue  enthusiasm  at 
a  football  match,  but  when  weeks  pass  by  and  the 
hoarseness  appears  to  have  come  to  stay,  you  should 
lose  no  further  time  in  ascertaining  positively  its 
cause,  even  if  you  are  feeling  quite  fit  in  every 
other  way. 

There  is  much  tuberculosis  among  the  North 
American  Indians,  and  it  is  wonderful  how  their 
resistance  and  outdoor  life  enable  them  to  do  hard 
work  for  years  while  suffering  from  the  disease. 
It  is  no  very  exceptional  thing  to  see  a  redskin, 
while  tumping  on  his  head  and  shoulders  a  load  of 
two  or  three  hundred  pounds  over  a  rocky  portage, 
bring  up,  at  every  few  hundred  yards,  sputum 
colored  with  blood,  and  it  sometimes  happens  that 
an  Indian  will  have  a  small  hemorrhage  at  one  end 
of  a  portage,  and  then  go  back  for  another  load. 
Should  it  ever  be  your  experience  to  cough  up 
blood,  or  to  continuously  bring  up  blood-stained 
sputum,  let  no  one  soothe  you  into  imagining  that 
there  is  not,  underlying  it,  a  serious  reason.  Con- 
clude positively  that  you  have  tuberculosis,  and  hold 
to  this  opinion  until  a  competent  doctor,  or,  if  need 
be,  a  specialist,  has  proved  to  you  definitely  that 
there  is  another  reason  to  account  for  it. 

The  great  majority  of  people  who  develop  tuber- 
culosis before  becoming  aware  that  they  have  any 
trouble  are  under  the  standard  of  weight  for  per- 
sons of  their  age  and  height.  It  sometimes  happens 
that  marked  loss  of  weight  is  the  only  cloud  that 
appears  on  the  horizon  long  before  the  storm  of 
battle  breaks.    Look  to  the  following  table  which 


78  THE  BATTLE  WITH  TUBERCULOSIS 

is  based  on  the  average  weight  of  77,178  healthy 
individuals,  and  if  you  find  your  weight  is  below  the 
average,  it  is  well  that  you  should  endeavor  to  in- 
crease it.  If  it  be  far  below  the  average  it  would 
be  well  to  search  diligently  for  the  cause. 

Table  Showing  Average  Weight  for  Height  and  Age, 
Based  on  Tables  Constructed  by  Oscar  H.  Rogers,  M.D., 
FROM  the  Recorded  Heights  and  Weights  of  74,162 
Insured  Males  and  3,016  Females.  The  Heights  were 
Taken  in  Shoes  and  the  Weights  in  Ordinary  Clothes 
Without  Coat,  or  Without  Coat  and  Vest.* 

Male 

Age  5  ft.  S't"   S'2"  S'3"  S'4"  S'5"  5'6"  s'7"  S'8"  S'9"  s'lo"  s'n"  6ft. 

20  114  117  121  125  128  132  136  140  144  149  153  158  163 

22  116  119  123  126  130  134  138  142  146  151  155  160  165 

24  117  120  124  128  131  136  139  144  148  153  157  162  167 

26  118  122  126  129  133  137  141  145  150  154  159  164  169 

28  120  123  127  130  134  138  142  147  151  156  161  166  170 

30  121  124  128  132  136  140  144  148  152  157  162  167  172 

32  122  125  129  133  137  141  145  150  154  159  164  169  173 

34  123  126  130  134  138  142  147  151  155  160  165  170  175 

36  124  127  131  135  139  143  148  152  156  161  166  172  176 

38  124  128  132  136  140  144  149  153  158  162  167  173  177 
40  125  129  133  136  141  145  149  154  158  163  168  173  178 

Female 

Age  4'I0"  4'XI"  Sft.  S'l"  5'a''  5'3"  5'4"  S'S"  5'6"  5'7"  s'8"  sV  S'lo" 
20  103  106  109  113  117  120  123  127  130  134  138  142  147 
22  105  107  110  114  118  121  124  128  132  136  140  144  149 
24  106  108  III  115  119  122  126  129  133  137  141  145  150 

26  107  no  113  117  120  124  127  131  134  139  143  147  151 

28  108  111  114  118  121  125  128  132  136  140  144  149  153 
30  109  112  115  119  123  126  129  133  137  141  146  150  154 

32  no  113  116  120  124  127  131  135  138  143  147  151  156 
34  no  114  117  121  125  128  132  136  140  144  149  153  157 

36  112  115  119  122  126  130  133  137  141  146  150  154  159 

38  113  116  120  123  127  131  135  139  142  147  152  156  161 

40  114  117  121  124  128  132  135  140  144  148  153  157  162 

Cough  has  not  been  mentioned  earlier  in  this 
chapter  because  what  the  majority  of  people  under- 

*  Taken  from  Osier's  "  Modern  Medicine,"  vol.  iii,  page  328. 


WAR  CLOUDS  79 

stand  by  cough  is  lia:ble  to  be  a  late  manifestation 
of  the  battle  that  is  in  progress.  To  be  sure,  there 
nearly  always  occurs  fairly  early  in  the  disease  a 
little  tickling  of  the  throat  which  causes  you  to 
occasionally  clear  it,  or  to  give  that  insignificant 
variety  of  cough  that  sounds  like  "  nervousness," 
affectation,  or  a  desire  to  attract  somebody's  atten- 
tion. Bewaire  of  the  so-called  "  stomach  cough." 
Stomach  cough  it  may  be,  but  a  tendency  towards 
indigestion  or  nervous  dyspepsia  is  notoriously  a 
war  cloud.  Likewise,  be  very  suspicious  of  a  cough 
that  comes  with  "  malaria."  Malaria,  as  a  matter 
of  fact,  is  seldom  complicated  by  bronchitis,  and 
very  often  is  a  misnomer  that  permits  tuberculosis 
to  run  on  undetected  for  months.  A  summer 
"  cold  "  in  a  person  under  forty,  unless  a  definite 
cause  be  known  for  it,  or  a  cold  that  clears  up  for 
a  while,  but  keeps  constantly  coming  back,  should 
make  you  earnest  in  seeking  the  information  that 
may  save  your  life. 

It  sometimes  happens  that  doctors,  as  well  as 
many  other  people,  make  the  mistake  of  imagining 
that  pleurisy  is  a  disease  in  itself.  Pleurisy  is,  at 
best,  only  a  war  cloud;  it  is  the  smoke  of  a  smolder- 
ing conflagration,  and,  once  it  appears,  it  should 
put  you  ever  on  the  alert  for  trouble  that  may  not 
break  out  until  many  years  later.  There  are  sev- 
eral conditions  which  cause  pleurisy,  but  the 
pleurisy  for  which  no  cause  can  be  found  is  gener- 
ally a  symptom  of  the  silent  battle  with  the  tubercle 
bacillus.  Likewise,  continuous  oppression  in  the 
chest,  or  constantly  recurring  fleeting  pains  in  the 
same  region  should  put  you  on  your  guard.    Finally, 


So  THE  BATTLE  WITH  TUBERCULOSIS 

there  is  a  form  of  abscess  which  occurs  close  to 
the  rectum,  and  which  is  known  as  an  "  ischiorectal 
abscess  " ;  this  is  frequently  the  first  sign  that  some- 
where in  the  body  a  battle  against  the  tubercle 
enemy  is  going  on.  It  often  leaves  a  discharging 
opening  which  does  not  heal. 

There  are  many  people  who  discount  symptoms 
of  tuberculosis  occurring  in  themselves,  and  who 
rest  in  an  utterly  false  security  through  the  thought 
that  the  disease  has  never  occurred  in  their  particu- 
lar family,  and  is  therefore  unlikely  to  occur  in 
them.  As  a  rule  there  is  far  too  much  stress  laid 
on  hereditary  tendencies,  and  that  stress  is  laid 
too  markedly  on  the  one  disease,  tuberculosis.  As 
a  matter  of  fact,  weakness  of  any  and  every  kind 
in  the  parent  is  to  some  degree  inherited  by  the 
child,  and  makes  him  just  that  much  more  open 
to  attack  from  the  tubercle  enemy.  The  child  of 
the  syphilitic  parent,  of  the  drunkard,  or  the  parent 
with  defective  mentality,  is  often  predisposed  to 
tuberculosis  just  as  much  as  is  the  child  of  the 
tuberculous  parent.  Further,  two  patients  in  every 
three  come  from  families  where  tuberculosis  is 
imknown. 

The  fact  that  you  have  recently  been  successful 
in  passing  a  medical  examination  for  life  insurance 
means  practically  nothing,  so  far  as  incipient  tuber- 
culosis is  concerned.  Such  examinations  are  gener- 
ally too  casual  to  detect  anything  but  a  flagrant 
tuberculous  condition  in  the  chest.  There  is  no 
disease  in  which  the  importance  of  early  discovery 
is  as  great.  In  the  case  of  tuberculosis,  the  old 
proverb  should  read :  "  A  stitch  in  time  saves  nine 


WAR  CLOUDS  8l 

hundred."  There  is  no  disease  the  discovery  of 
which  occasions  greater  surprise,  and  for  years 
after  its  contraction  you  never  cease  to  wonder  that 
it  is  actually  you  who  are  its  victim.  Therefore, 
put  not  your  faith  in  heredity,  nor  in  the  invulner- 
ability of  your  own  strength,  but  when  the  clouds 
of  war,  be  they  ever  so  small,  appear  with  shadowy 
uncertainty  on  the  distant  horizon,  gird  yourself  for 
the  conflict,  and,  with  a  heart  prepared  for  the 
worst,  and  a  mind  manfully  determined  to  learn  the 
truth,  do  not  rest  content  until  the  verdict  has  been 
scientifically  secured. 


6 


CHAPTER  X 
The  Intelligence  Department 

Every  one  who  knows  anything  about  war  de- 
partments and  military  methods  will  realize  how 
comparatively  helpless  a  country  or  an  army  would 
be  without  an  intelligence  department  to  secure 
accurate  information  on  matters  pertaining  to  mili- 
tary necessities  and  the  condition  of  the  country, 
and  to  impart  such  information  to  the  director  gen- 
eral. In  days  of  peace,  the  work  of  the  intelligence 
department  is,  naturally,  much  reduced;  it  seeks, 
nevertheless,  to  keep  in  touch  with  the  activities  of 
any  and  every  possible  enemy.  Should  an  enemy 
seekan  invasion,  the  intelligence  department,through 
its  special  information,  is  the  first  to  discover  the 
fact,  and  when  invasion  actually  does  take  place, 
the  intelligence  department  is  indispensable  in  giv- 
ing information  regarding  the  size,  the  position,  and 
the  strength  of  the  enemy.  Imagine  a  general  un- 
dertaking to  lead  his  army  to  victory  without  being 
confident  that  a  war  was  in  progress ;  without  hav- 
ing ascertained  the  location  of  the  enemy,  and  with- 
out having  the  slightest  idea  of  the  course  he  should 
follow  to  gain  an  advantage !  Such  a  man  would 
be  a  fool,  not  a  general. 

You  are  the  general  of  an  army  of  billions  of 

white  cells,  not  to  mention  the  other  forces.    Their 

destiny  lies  to  a  great  extent  in  your  keeping.    Have 

you  instituted  an  intelligence  department  that  is 

8a 


THE  INTELLIGENCE  DEPARTMENT  83 

giving  you  accurate  information  and  advice?  Do 
you  know  whether  or  not  your  forces  are  at  war? 
Do  you  know  the  character  of  the  enemy  ?  Do  you 
know  what  course  to  follow  to  avoid  ambush,  sur- 
prise, annihilation  ? 

An  amusing  and,  at  the  same  time,  sad  character- 
istic of  many  a  man  whose  health  is  failing  is  that 
he  derives  pleasure  through  being  deceived,  or 
"  bluffed,"  as  the  world  terms  it.  It  matters  not 
that  he  knows  he  is  being  deceived.  The  assurances 
which  he  so  cherishes  are  not  open  to  criticism  or 
analysis ;  they  are  accepted  at  face  value.  They  are 
so  soothing  that  even  when  he  can  no  longer  get  his 
friends  to  deceive  him,  he  continues  to  deceive  him- 
self. In  his  deepest  consciousness  he  has  a  realiza- 
tion that  it  is  all  untrue,  that  it  cannot  last,  but  the 
fact  is  he  is  not  made  of  the  stuff  that  can  look 
danger  and  trouble  squarely  in  the  face.  Anything 
that  may  possibly  help  and  which  may  serve  to 
avoid  an  actual  declaration  of  war  is  acceptable. 
One  day,  while  reading  the  newspaper,  he  makes  a 
discovery.  On  the  third  page  there  is  advertised  the 
very  medicine  for  his  case.  It  says  that  it  cures 
tired  feeling,  cough,  pain  in  the  joints,  skin  rashes, 
falling  hair,  and  many  other  conditions.  He  has  no 
skin  rashes,  falling  hair,  or  pain  in  the  joints,  but 
he  always  feels  tired  and  has  a  cough,  and  as  those 
are  the  first  things  mentioned,  the  medicine  is  sure 
to  be  just  the  thing  he  needs.  He  is  so  sure  it  will 
help  him  that  he  feels  better  for  a  while  after  taking 
it.  He  doesn't  know  that  the  first  essential  of  every 
tonic  patent  medicine  is  a  stimulant,  and  the  stimu- 
lant gives  him  a  temporary  boost.    But  the  effect 


84  THE  BATTLE  WITH  TUBERCULOSIS 

soon  wears  off.  In  the  meantime,  he  has  found 
another  preparation  that  he  is  sure  is  better  than  the 
previous  one,  and  so  the  poor  fellow  goes  along  try- 
ing many  of  the  five  hundred  so-called  cures  for 
tuberculosis.  In  the  United  States  alone  these  cures 
bring  to  their  manufacturers  an  annual  income  of 
fifteen  million  dollars. 

If  you  have  failed  to  do  so,  lose  no  time  in  search- 
ing your  mind.  Try  to  rise  above  desire  and  fear, 
and  look  facts  squarely  in  the  face.  Are  you  letting 
other  people  bluff  you  about  your  health  ?  Are  you 
bluffing  yourself?  Are  you  depending  on  some 
vague  chance,  such  as  a  patent  medicine,  to  pull  you 
out  of  a  condition  which  in  your  innermost  soul 
you  know  is  serious  ?  Strength  lies  in  truth,  weak- 
ness in  deception.  Therefore,  institute  an  intelli- 
gence department  that  will  give  you  the  truth.  The 
medical  profession  is  your  intelligence  department. 
Note  the  relationship.  The  doctor  is  not  the  gen- 
eral, he  is  not  the  leader  of  your  forces.  All  he 
can  do  is  to  supply  information,  to  point  out  the 
pitfalls,  to  tell  you  where  lies  safety  and  where  lies 
danger.  You  are  the  general  and  chief  commander. 
You  alone  are  responsible  for  your  actions,  you 
alone  must  marshal  your  forces,  and  you  it  is  who 
determines  the  personnel  of  your  headquarters 
staff.  Naturally,  if  your  chief  medical  adviser  gives 
bad  advice,  you  are  liable  to  make  grave  errors. 
Therefore,  spare  neither  pains  nor  money  in  making 
certain  that  the  doctor  you  choose  is  trustworthy. 

From  the  accounts  of  one  writer,^  it  would  seem 
that  many  members  of  the  medical  profession  are 

*  Thomas  Crawford  Galbreath  in  his  book  "  T.  B." 


THE  INTELLIGENCE  DEPARTMENT  85 

open  to  censure  for  apparent  failure  to  recognize 
tuberculosis  in  its  incipient  stage.  He  mentions  two 
prominent  sanatoria  which  conducted  investigations 
and  declared  that  a  mistake  had  been  made  in  the 
diagnoses  of  the  conditions  of  about  50  per  cent,  of 
the  patients  previous  to  their  entry.  Certainly  the 
extraordinary  statements  of  many  patients  in  health 
resorts  would  confirm  the  opinion  that  some  doctors 
are  deficient  in  the  necessary  knowledge  and  skill 
pertaining  to  the  diagnosis  and  treatment  of  tuber- 
culosis. As  is  usually  the  case,  however,  there  are 
two  sides  to  the  story. 

What  we  don't  understand,  we  fear,  and  although 
tuberculosis  has  been  known  and  studied  since  be- 
fore the  time  of  Hippocrates  (b.  c.  460-376),  it  is 
only  within  the  last  few  years  that  the  public  has 
begim  to  get  a  very  imperfect  idea  of  its  cause  and 
effect.  As  a  consequence,  the  word  tuberculosis, 
or  consumption,  has  in  the  past  filled  the  lay  mind 
with  dread,  and  even  to-day  the  country  is  full  of 
phthisiophobists. 

No  words  could  better  picture  the  fate  of 
a  consumptive  in  the  years  gone  by  than  ex- 
tracts from  a  letter  of  George  Sand  written  at 
Marseilles  on  her  return  from  a  trip  to  the  Island 
of  Majorca,  whither  she  went  in  the  winter  of 
1838-39  in  a  vain  search  for  health  for  her  friend 
and  protege,  Chopin:  ^  *'  The  landlord  of  the  little 
house  which  we  had  rented  turned  us  brutally  out- 
of-doors,  and  wanted  to  proceed  against  us  legally 
in  order  to  force  us  to  give  a  fresh  coat  of  plaster 

'  To  M.  Frangois  Rollinal,  a  Chateauroux,  "  Correspondence 
de  George  Sand,"  vol.  ii. 


86  THE  BATTLE  WITH  TUBERCULOSIS 

to  his  house,  infected  by  contagion.  The  native 
jurisprudence  would  have  plucked  us  like  chickens. 
.  .  .  We  had  there  the  utmost  difficulty  in  pro- 
curing the  most  common  nourishment  that  the 
island  produces  in  abundance,  thanks  to  the  ill 
will  and  thievish  spirit  of  the  natives,  who  made 
us  pay  for  things  almost  ten  times  their  value.  So, 
indeed,  we  were  at  their  mercy,  and  in  danger 
of  perishing  of  starvation.  .  .  .  Chopin  grew 
steadily  worse  and  in  spite  of  all  the  so-called 
offers  of  services  that  were  made  us  in  truly  Span- 
ish fashion,  we  hadn't  found  one  house  which 
would  offer  us  its  hospitality,  in  the  whole  island. 
Finally,  we  resolved  to  depart  at  any  price,  even 
though  Chopin  had  not  the  strength  to  drag  him- 
self along.  We  asked  one  single,  one  first,  one  last 
service:  A  carriage  to  carry  us  to  Palma,  whence 
we  wished  to  embark.  This  service  was  refused 
us,  although  our  friends  had  every  sort  of  equi- 
page. We  have  perforce  to  journey  three  leagues 
on  execrable  roads  in  a  wheelbarrow  or  in  a  bath- 
chair.  On  arriving  at  Palma,  Chopin  had  a  terrible 
hemorrhage.  We  set  off  the  next  day  on  the  only 
steamboat  of  the  island,  which  is  used  to  transport 
pigs  to  Barcelona.  No  other  way  of  quitting  this 
cursed  country!  We  were  in  company  of  one  hun- 
dred pigs,  whose  continual  cries  and  foul  odor 
left  our  patient  no  rest  and  no  respirable  air.  The 
hemorrhage  continued  right  to  Barcelona,  and  he 
dragged  himself  along  like  a  spectre."  This  was 
in  1838,  but  many  people  to-day  are  just  a^ 
ignorant,  just  as  unreasoning,  and  just  as  heart- 
less in  their  attitude  toward  tuberculous  patients, 


THE  INTELLIGENCE  DEPARTMENT  87 

but  they  dare  not  exhibit  their  feeHngs  quite  as 
callously  as  did  the  people  under  whose  maledic- 
tions Chopin  suffered. 

Imagine,  if  you  can,  the  effect  of  telling  a  person 
of  this  type  that  he  or  she  has  tuberculosis!  A 
doctor  soon  learns  from  experience  that  in  making 
such  a  statement  he  must  expect  to  be  maligned  and 
slandered  as  an  alarmist  and  a  quack.  Then,  there 
are  these  three  important  facts :  First,  tuberculosis 
in  its  earliest  stages  is  most  difficult  to  distinguish 
from  several  minor  ailments  of  little  significance; 
second,  in  incipiency  it  is  most  difficult  to  con- 
vince the  tuberculous  patient  that  he  has  anything 
wrong  with  him.  He  generally  looks  well  and 
feels  pretty  well,  a  condition  which  he  imagines  is 
quite  incompatible  with  tuberculosis.  Third,  the 
majority  of  incipient  cases  clear  up  quickly  with 
comparative  rest.  There  are  many  people  who 
have  had  incipient  tuberculosis  which  has  healed 
without  knowledge  on  their  part  of  their  having 
had  anything  the  matter  with  them.  The  doctor 
who  tells  his  patient  that  he  is  suffering  from  in- 
cipient tuberculosis  has  to  be  positive  of  his  diag- 
nosis, and  make  his  statement  knowing  that  it  may 
be  taken  as  an  insult,  that  the  patient  will  doubtless 
alter  his  way  of  living  because  he  has  been  fright- 
ened, that  he  will  probably  get  well,  and,  if  so,  will 
most  certainly  hold  the  doctor  up  to  unjust  ridicule 
in  the  community.  For  this  reason,  many  doctors 
will  not  diagnose  tuberculosis  until  they  find  the 
tubercle  bacilli  in  the  patient's  sputum,  and  as 
Lawrason  Brown  says,  "  He  who  always  waits 
for  tubercle  bacilli  to  appear  in  the  sputum  before 


88  THE  BATTLE  WITH  TUBERCULOSIS 

making  a  positive  diagnosis  is  apt  to  come  to  the 
conclusion  that  many  cases  of  pulmonary  tubercu- 
losis have  slight  chances  of  recovery."  There  is 
no  question  as  to  what  a  doctor's  duty  is,  ridicule 
or  no  ridicule;  but  doctors,  like  ministers  and 
lawyers,  are  human. 

Many  a  doctor  suspects  tuberculosis  and  hints 
his  suspicion  as  strongly  as  he  deems  wise,  but  a 
patient  is  very  slow  to  take  a  hint  that,  when 
acted  upon,  is  going  to  change  his  whole  life.  As 
a  rule  it  does  not  suffice  to  tell  a  patient  he  has 
tuberculosis.  Speaking  metaphorically,  one  has  to 
hammer  it  in  with  a  sledge  hammer  before  many  a 
patient  will  consent  to  follow  the  treatment,  and  it 
is  open  to  question  just  how  far  a  doctor  is  justi- 
fied in  exercising  persuasion.  Many  a  doctor  who 
makes  a  perfectly  correct  diagnosis  of  tubercu- 
losis is  slandered  and  misrepresented  in  after-years 
because  he  did  not  force  an  unwilling  patient  to 
follow  the  proper  treatment.  Many  a  patient  when 
he  comes  face  to  face  with  death  is  apt  to  blame 
anybody  and  everybody  rather  than  himself.  How 
often  we  have  heard  a  patient  say — "  When  the 
doctor  told  me  that,  he  so  discouraged  me  that  I 
became  perfectly  reckless";  and  how  often  we 
have  heard  another  say — "  If  the  doctor  had  only 
told  me  the  whole  truth  I  should  have  acted  very 
differently !  "  Please  note  that  in  both  instances 
it  is  the  doctor  who  is  to  blame ! 

Any  physician  who  has  ever  been  a  patient,  and 
has  received  the  confidences  of  other  tuberculous 
patients,  can  tell  you  of  the  countless  foolish  mis- 
understandings which  arise  between  doctor  and 


THE  INTELLIGENCE  DEPARTMENT  89 

patient  simply  because  their  points  of  view  are  so 
far  removed  from  each  other.  Take,  for  example, 
the  word  "cavity"  which  the  doctor  may  have 
occasion  to  mention.  To  the  dentist  the  word  has 
one  meaning,  but  to  the  excavator  it  may  mean 
something  very  dififerent.  If  a  patient  had  had 
five  years  of  hard  study  in  a  school  of  medicine, 
it  might  be  reasonable  for  him  to  expect  a  perfectly 
straight  answer  to  many  of  his  questions,  but 
it  must  not  be  forgotten  that  a  doctor  is  em- 
ployed not  as  a  teacher,  but  as  a  reliever  of  suffer- 
ing, and  it  is  the  doctor's  business  to  decide  what 
information  will  tend  to  relieve  suffering,  and 
what  information  will  tend  to  add  to  suffering,  and 
it  is  his  duty  to  withhold  the  latter  information. 
When  three  or  four  years  have  passed  by  and  you 
are  still  "  chasing  "  the  elusive  cure,  do  not  be  too 
harsh  in  your  criticism  of  the  old  family  doctor 
who,  out  of  the  kindness  of  his  heart,  let  you  down 
very  easily  by  saying  it  was  only  a  matter  of  a 
few  months  before  you  would  be  back  at  work. 
Perhaps  he  misjudged  your  case,  and  perhaps  he 
judged  it  with  accuracy  and  an  insight  which  took 
into  account  your  mind  as  well  as  your  body. 


CHAPTER  XI 
The  Chief  Medical  Officer 

In  every  business  and  profession  there  are  men 
of  widely  varying  intellects  and  character.  A  few  are 
artists  in  their  work,  the  majority  are  mediocre; 
some  are  dunderheads,  and  a  scattered  few  are  a 
disgrace  to  their  calling.  In  a  profession  which 
has  as  its  one  purpose  the  alleviation  of  suffering 
and  distress,  it  is  difficult  to  realize  that  inefficiency 
and  wickedness  can  find  a  place.  But  just  as  there 
are  good  carpenters  and  bad  carpenters,  good 
brokers  and  bad  brokers,  good  ministers  and  bad 
ministers,  so  there  are  good  doctors  and  bad 
doctors.  In  no  other  profession,  possibly,  is  the 
opportunity  for  either  goodness  or  badness  so 
manifest,  and  in  no  other  profession  can  badness 
prosper  to  such  a  degree. 

In  the  medical  profession,  as,  indeed,  in  all 
professions,  there  are  two  kinds  of  badness,  active 
and  passive.  Active  badness  or  wickedness  in  a 
doctor  is  disclosed  in  aggressive  attempts  to  de- 
ceive, defraud,  or  to  make  money  illegitimately, 
or  on  false  pretences.  Passive  badness  is  revealed 
in  ignorance,  laziness,  inefficiency,  and  carelessness. 
The  former  is  often  the  outcome  of  the  latter.  It 
is  very  difficult  for  a  layman  to  judge  who  is  a 
good  doctor,  and  who  is  a  bad  one.  Many  patients 
criticise  a  doctor  adversely  for  following  a  line  of 
treatment  which  is  not  only  scientific  but  is  in  all 
90 


THE  CHIEF  MEDICAL  OFFICER  91 

respects  the  treatment  indicated  for  the  particular 
case.  On  the  other  hand,  an  unprofessional  and 
unscientific  medical  man  is  sometimes  pointed  out 
by  some  good  lady  as  "  the  best  doctor  in  town." 
Doctors  themselves  often  have  difficulty  in  deter- 
mining the  standing  of  one  another,  but  they  are 
in  a  much  better  position  to  ascertain  accurately 
than  anyone  outside  of  the  profession.  While 
doctors  are  not  prepared  to  pass  judgment  on  the 
professional  ability  and  integrity  of  each  other,  they 
nevertheless  have  examinations  and  a  set  of  laws 
known  as  medical  ethics,  and  a  doctor  who  does  not 
come  up  to  the  standard  set  by  the  profession  is 
naturally  looked  down  upon  by  his  brother  prac- 
titioners. You  would  be  wise  not  to  choose  such 
a  doctor  as  your  chief  medical  adviser.  A  right- 
minded  medical  man  cherishes,  above  everything 
else,  the  respect  of  his  brother  physicians,  and  will 
not  openly  go  contrary  to  medical  ethics,  provided 
honor  means  more  to  him  than  money,  and  he  has 
the  ability  to  make  a  living  as  a  regular  prac- 
titioner. 

A  doctor  who  advertises  himself  and  his  cures 
in  the  newspapers,  or  on  pamphlets  for  the  public, 
has  sacrificed  the  respect  of  the  profession,  and 
you  would  be  wise  to  have  nothing  to  do  with  him 
and  his  "  cure."  When  a  cure  for  tuberculosis,  or 
any  other  cure  worth  the  name,  is  discovered,  the 
discoverer  will  not  have  to  pay  money  out  of  his 
own  pocket  to  advertise  it  in  the  local  press.  Even 
if  he  be  a  country  doctor  in  some  obscure  hamlet, 
he  knows  the  way  is  open  to  him  to  present  his 
facts  in  a  legitimate  manner  to  the  nearest  medical 


92  THE  BATTLE  WITH  TUBERCULOSIS 

society,  and  if  his  facts  stand  the  Hght  of  investi- 
gation, he  will  be  heralded  far  and  wide,  not  in 
one  country  only,  but  throughout  the  world,  as  a 
benefactor  of  mankind.  No  better  advertisement 
for  a  doctor  is  needed  than  work  well  done.  If 
he  does  good  work,  he  will  get  all  the  patients  he 
can  take  care  of  without  having  to  resort  to  the 
newspapers. 

Beware,  also,  of  the  doctor  who  tries  to  make 
capital  out  of  criticising  the  members  of  his  own 
profession  and  their  work.  Nothing  is  gained  for 
a  patient  by  sowing  seeds  of  discontent  over  mat- 
ters that  are  passed  and  gone.  The  work  of  a 
doctor  is  to  deal  with  the  present  and  the  future, 
and  he  who  tries  to  rise  on  the  faults  of  his 
brethren  does  so  because  he  realizes  his  inability 
to  rise  on  the  honorable  basis  of  work  well  done. 

It  is  not  always  the  most  successful  doctor  or 
the  doctor  with  the  largest  practice  who  is  the 
cleverest.  Many  of  the  best  qualified  physicians 
get  utterly  out  of  patience  with  the  ignorance, 
opposition  and  foolish  questioning  of  some  sick 
people,  and  in  no  way  attempt  to  conceal  the  fact. 
This  does  not  increase  business.  Generally  the 
most  successful  doctor  from  the  business  stand- 
point is  the  one  who  possesses  that  rare  persuasive 
force  which  compels  patients  to  accept  his  advice, 
and  act  upon  it,  without  his  being  obliged  to  enter 
into  explanations. 

In  choosing  your  chief  medical  adviser,  pass  by 
Doctor  Advertiser,  Doctor  Knocker,  Doctor 
Boozer,  Doctor  Gambler,  and  Doctor  Hipped,  and 
look  for  a  doctor  you  believe  to  be  scientific,  ear- 


THE  CHIEF  MEDICAL  OFFICER  93 

nest,  thorough,  high-minded,  and  one  who  does  not 
stake  everything  on  some  special  hne  of  treat- 
ment. When  you  consult  him,  remember  that  he 
makes  no  pretence  at  being  a  clairvoyant — tell 
him  frankly  everything  about  yourself  you  feel 
he  should  know.  If  you  have  been  the  victim  of 
your  own  folly,  tell  him  that  also — ^he  is  used  to 
hearing  such  things,  and  you  will  find  him  sympa- 
thetic. If  you  hold  anything  back,  please  do  not, 
at  a  later  date,  blame  him  for  making  a  mistake. 
During  his  examination,  should  he  make  the  slightest 
hint  regarding  tuberculosis,  it  is  not  sufficient  that 
you  should  refrain  from  looking  as  though  you 
were  going  to  stampede,  but,  rather,  you  should 
realize  that  it  has  taken  some  courage  on  the  doc- 
tor's part  to  even  hint  at  tuberculosis,  and  you 
ought  to  follow  up  the  hint  with  all  the  assiduity 
you  can  muster.  Further,  it  can  do  no  harm,  and 
possibly  it  may  do  a  great  deal  of  good,  for  you 
to  ask  the  doctor  quite  frankly  whether  there  is 
anything  about  your  condition  which  simulates 
tuberculosis.  There  is  nothing  inconsistent  or 
ridiculous  in  the  question,  even  if  you  are  a  big, 
fat  and  powerful-looking  man. 

During  the  last  few  years,  startling  conditions 
have  been  discovered  through  medical  examinations 
of  large  numbers  of  individuals,  irrespective  of  any 
known  ailment  or  disability.  In  one  instance,  out  o  f 
two  thousand  men  and  women  examined,  70  per 
cent,  had  impairments  of  a  serious  nature.  Out  of 
thousands  who  had  thus  been  found  to  be  impaired, 
only  10  per  cent,  imagined,  before  the  examination, 
that  they  had  had  anything  wrong  with  them.    For 


94  THE  BATTLE  WITH  TUBERCULOSIS 

this  reason  the  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis  has  set  apart  a 
special  day,  December  8th  of  every  year,  on  which 
it  suggests  that  everybody,  irrespective  of  his 
physical  feelings,  should  go  to  his  doctor  and  have 
a  general  overhauling  with  a  view  to  the  discovery 
of  any  possible  pathological  condition  which  may 
exist  unknown  to  the  patient.  If  such  a  system 
were  universally  adopted,  tuberculosis  would  cer- 
tainly no  longer  cause  one-third  of  all  deaths  be- 
tween the  ages  of  fifteen  and  forty-four. 

Where  one  member  of  the  family  is  found  to 
be  suflfering  from  tuberculosis,  it  becomes  highly 
important  that  the  remaining  supposedly  healthy 
members  of  the  family  should  go  to  a  doctor  for 
an  examination. 

It  has  been  found  that  in  the  families  of  from  40 
to  60  per  cent,  of  a  large  group  of  tuberculous  pa- 
tients examined  to  demonstrate  this  point,  one  or 
more  members  of  the  same  household  had,  or,  at 
an  earlier  date,  had  had,  the  same  affliction. 

If  you  go  to  a  doctor  for  an  examination  for 
tuberculosis,  or  if  such  an  examination  is  indicated 
by  your  symptoms,  it  is  not  sufficient  for  the  doc- 
tor to  listen  to  your  chest  through  your  clothing  or 
even  under  it.  He  should  insist  that  you  should 
take  off  all  garments  above  your  waist,  and  he 
should  examine  the  back  as  thoroughly  as  the 
front  of  your  chest.  If  you  are  in  the  habit  of 
coughing  up  sputum,  he  should  have  you  bring 
him  a  specimen,  or  direct  you  how  and  where  to 
send  it  for  a  microscopical  examination.  After 
the  doctor  has  full  details  on  all  the  points  neces- 


THE  CHIEF  MEDICAL  OFFICER  95 

sary,  he  should  be  able  to  tell  you  definitely 
whether  or  not  there  is  active  trouble  in  your  chest. 
If  there  should  be  the  slightest  note  of  indecision 
or  question  in  what  he  has  to  say,  your  course  is 
plain.  You  wish  a  consultation.  No  right-think- 
ing doctor  will  take  offence  at  such  a  proposal,  and 
even  if  he  should  take  offence,  remember  it  is  your 
life,  not  his,  that  is  in  the  balance. 

In  choosing  a  doctor  for  a  consultation,  in  order 
to  determine  the  diagnosis  of  a  condition  which 
may  change  your  whole  life,  you  should  go  very 
carefully,  and  refuse  to  have  anyone  who  is  not 
to  your  knowledge  highly  skilled  in  his  work. 
Generally  speaking,  you  should  go  to  a,  lung 
specialist,  one  who  is  a  recognized  authority  on 
tuberculosis,  or  one  who  is  connected  with  a  sana- 
torium for  the  treatment  of  tuberculous  patients. 
If  such  a  doctor  is  not  known  to  you,  write 
to  the  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis,  New  York  City, 
and  ask  its  secretary  what  doctor  in  your 
district  he  can  recommend.  Allow  the  specialist 
to  carry  out  what  tests  he  deems  necessary,  such 
as  the  use  of  tuberculin,  or  the  taking  of  an  X-ray 
photograph.  With  these  tests  and  others  he  will 
be  able  to  tell  you  to  a  practical  certainty  whether 
or  not  you  have  tuberculosis.  The  money  you 
spend,  in  making  assurance  doubly  sure  on  this 
score,  is  worth  its  weight  ten  times  over. 

It  is  possible  that  a  doctor  may  tell  you  that 
you  have  tuberculosis,  and  you  may  doubt  the  cor- 
rectness of  his  diagnosis.  You  are  not  exactly 
to  blame  for  your  doubts,  but  do  not  rest  content 


g6  THE  BATTLE  WITH  TUBERCULOSIS 

until  you  are  absolutely  convinced  of  the  truth. 
Further,  do  not  start  treatment  for  tuberculosis 
until  your  are  quite  convinced  that  you  have  the 
disease.  Imagine,  as  already  suggested,  a  general 
setting  out  to  lead  an  army  to  battle  and  not  being 
convinced  that  a  condition  of  war  exists!  He 
would  naturally  regard  the  whole  thing  as  some- 
what of  a  joke.  There  are  many  patients  who  come 
to  sanatoria  in  exactly  this  very  frame  of  mind. 
They  are  carrying  out  the  treatment,  but  they  don't 
believe  they  have  anything  wrong  with  them. 
When  a  serious  battle  is  treated  as  a  joke,  it  re- 
quires little  foresight  to  predict  what  the  end 
will  be. 

Develop  a  high  regard  for  the  doctor  who  tells 
you  the  facts  about  your  condition  irrespective  of 
your  feelings.  It  may  come  as  a  shock  to  you  to 
learn  the  truth,  but  in  fact  there  are  very  few  tuber- 
culous patients  who  do  not  recover  from  the  shock 
a  little  more  rapidly  than  is-  desirable.  To  know 
the  truth  is  to  build  your  house  on  a  rock,  and  to 
know  It  early  is  to  avoid  a  weak  foundation. 

Once  the  diagnosis  of  tuberculosis  has  been  ac- 
curately made,  although  you  are  greatly  depressed 
by  the  disclosure,  although  you  have  the  kindly 
assurance  that  it  is  all  of  little  significance,  that  you 
will  soon  return  to  work,  and  that  the  treatment 
will  be  a  happy  rest,  it  is  well  that  you  should 
realize,  and  realize  early,  that  you  have  come  to 
the  parting  of  the  ways,  and  that  two  roads  lie 
before  you — one,  the  pleasant  path  of  Self-indul- 
gence; the  other,  the  rough  road  of  Renunciation. 
The  one  is  smooth  and  inviting  to  travel.     It  is 


THE  CHIEF  MEDICAL  OFFICER  97 

filled  with  theatres  and  palm-gardens  and  card- 
parties,  motor-cars  and  joy-rides.  It  resounds 
with  laughter  and  gaiety,  its  evenings  are  long 
and  joyous,  but  it  is  shorter  than  most  thorough- 
fares, and  there  are  no  cross-roads,  so  that  should 
you  ever  wish  to  take  the  other  path,  you  will  have 
to  come  back  against  the  current  of  the  great  multi- 
tude travelling  towards  the  strange  figure  called 
Death,  which  is  disguised  in  radiant  robes  of 
pleasure,  and  which  stands  at  the  end  of  the  road 
beckoning  them  ever  onward.  The  road  of  Re- 
nunciation is  steep  and  rocky  and  is  anything  but 
inviting.  It  is  overgrown  with  taunts  and  jibes 
and  sneers,  and  it  is  overhung  with  a  darkness 
which  resembles  night.  But  just  over  the  first  sud- 
den ascent  the  sky  seems  to  lighten,  the  taunts  be- 
come fewer  and  are  replaced  by  flowers  of  respect. 
The  jibes  give  way  to  encouragement,  and  the  soil 
is  not  of  the  sort  where  sneers  can  grow.  It  is 
a  long,  lonely  road,  but  the  farther  you  travel,  the 
more  fascinating  becomes  its  strange,  new  light, 
and  finally,  away  in  the  distance,  you  discover  the 
dawn  of  a  new  day — a  day  of  greater  significance 
and  happiness  than  you  have  ever  before  known. 
Think  carefully  while  yet  there  is  time.  Which 
road  will  you  travel? 


CHAPTER  XII 

Choosing  the  Battleground 

A  DISTINGUISHING  characteristic  of  every  great 
general  is  his  abiHty  so  to  direct  his  army  that 
it  will  meet  the  enemy  on  ground  which  will  give 
all  possible  advantage  to  the  home  forces  and,  con- 
versely, put  the  enemy  at  the  greatest  possible  dis- 
advantage. It  often  happens,  however,  that  con- 
ditions make  it  imi>ossible  to  meet  the  foe  in  a 
place  which  offers  advantages,  and  it  sometimes 
becomes  necessary  to  make  a  stand  on  a  battlefield 
which  has  serious  drawbacks.  Naturally,  the 
greater  the  handicap  imposed  on  the  home  forces 
by  the  character  of  the  battleground,  the  more  seri- 
ously the  ingenuity  of  the  general  is  taxed.  While 
the  most  unfavorable  conditions  are  occasionally 
attended  by  success,  it  is  inconceivable  that  a  com- 
mander worthy  the  name  would,  through  prejudice 
or  self -gratification,  turn  his  back  on  a  battle- 
ground which  offered  distinct  advantages. 

In  your  battle  with  the  tubercle  bacillus,  no 
sooner  is  it  discovered  that  a  struggle  is  imminent 
than  you  are  faced  with  the  problem  of  choosing 
a  battleground.  If  you  are  able  to  put  aside  impulse 
and  desire,  and  allow  calm  reason  to  weigh  the 
various  considerations,  you  have  one  of  the  first 
attributes  of  the  successful  general.  Of  course, 
you  do  not  zmsh  to  go  away  and  leave  your  home, 
your  friends,  and  all  the  joys  that  have  been  yours, 
98 


CHOOSING  THE  BATTLEGROUND  99 

but  the  doctor  has  suggested  that  a  change  of  some 
sort  is  advisable  and  before  you  reject  the  doctor's 
advice  weigh  it  carefully,  and  consider  it  from  all 
points  of  view. 

You  have  doubtless  been  told  that  you  have  very 
little  trouble,  that  everything  will  be  well  in  a  few 
months  or  even  weeks.  It  is  possible  that  this 
may  turn  out  as  you  have  been  told,  but  if  you  have 
tuberculosis  that  can  be  demonstrated  as  such,  you 
ought  to  realize  that  your  way  of  living  must  be 
altered  for  the  remainder  of  your  life.  You  have 
perhaps  been  informed  in  what  way  your  living 
must  be  altered,  but  knowledge  is  one  thing  and 
the  application  of  knowledge  is  quite  another 
thing.  You  will  be  a  very  exceptional  patient,  and 
you  will  be  the  member  of  a  very  exceptional  family, 
if,  even  in  a  reasonable  time,  you  can  apply  the 
treatment  for  tuberculosis  as  it  should  be  applied 
in  your  home. 

You  will  do  splendidly  for  the  first  two  or 
three  weeks,  and  the  family  will  back  you 
up,  because  both  you  and  the  family  have  been 
badly  frightened,  but  in  the  course  of  a  month  or 
two,  when  you  look  like  the  healthiest  member  of 
the  household,  your  friends  will  begin  to  question 
whether  your  doctor  knows  what  he  is  talking 
about.  They  think  it  is  rather  a  joke  that  you  are 
not  allowed  to  see  them  when  they  drop  in  during 
your  rest  hour  in  the  afternoon,  and  they  secretly 
come  to  the  conclusion  that  you  are  just  a  "  little 
bit  hipped  "  about  your  health.  Gradually  your 
own  family  begins  to  question  "  all  this  business  of 


loo  THE  BATTLE  WITH  TUBERCULOSIS 

lying  around,"  and  you  happen  to  hear  some  one 
express  an  opinion,  not  intended  for  your  ears,  to 
the  effect  that  if  you  would  get  up  and  do  a  little 
work,  perhaps  you  would  forget  your  troubles. 
And  all  of  this  is  quite  in  accord  with  your  own 
feelings.  You  have  long  ago  begun  to  chafe  under 
the  confinement  of  the  treatment  the  doctor  has 
laid  down.  Long  ago  you  have  come  to  the  con- 
clusion that  it  is  all  fiddlesticks,  because  you  are 
feeling  fine  and  just  long  to  get  out  with  the  boys. 
In  your  opinion,  you  are  quite  the  exception  to 
other  tuberculous  patients.  This  rest  treatment 
may  be  all  right  for  the  other  fellow,  but  you  are 
quite  different  .  .  .  Go  question  the  poor  con- 
sumptive who  is  on  his  deathbed.  Did  he  consider 
himself  an  exception  in  the  early  days  of  his  dis- 
ease? He  will  tell  you  that  that  is  the  reason  he 
lost  all  chance  of  recovery. 

Take  heed  while  yet  there  is  time.  If  you  are 
to  win  your  battle,  you  must  be  saved  from  your- 
self. That  is  possible  under  right  conditions,  but 
it  is  much  more  serious  if,  at  the  same  time,  you 
have  to  be  rescued  from  the  harmful  influences  of 
your  family  and  your  friends.  It  is  one  thing  for 
a  doctor  to  treat  a  patient  and  enable  him  to  see 
the  wisdom  of  following  the  proper  treatment.  It 
is  a  vastly  different  and  much  more  difficult  thing 
for  the  doctor  to  have  to  treat  the  whole  family, 
and  educate  the  family's  many  friends.  Until  such 
time  as  you  are  a  veteran  in  the  struggle,  it  is  well 
that  you  should  free  yourself  of  home  handicaps, 
and  give  yourself  every  opportunity  to  acquire 


CHOOSING  THE  BATTLEGROUND  loi 

habits  which  will  have  to  be  practised  to  a  greater 
or  leas  degree  for  the  remainder  of  your  life. 

If  you  are  the  head  of  the  family,  or  the  one 
who  is  expected  to  solve  the  family's  problems, 
the  necessity  for  getting  away  is  all  the  more 
urgent.  In  addition  to  this,  there  is  the  important 
reason  that  a  change  of  surroundings  will  be  a 
stimulus  to  your  recreative  forces.  If  the  change 
can  be  made  to  purer  air  and  more  sanitary  condi- 
tions all  the  better,  but  any  change,  provided  it  is 
not  to  more  unsanitary  conditions,  is  better  than 
none.  But  where  should  you  go?  If  you  could 
find  a  hotel,  or  large-sized  boarding-house,  which 
does  not  aim  at  making  a  business  profit  out  of 
its  guests,  which  has  been  built  where  the  air  is' 
pure  and  favorable  to  health  seekers,  which  exer-j 
cises  enough  authority  over  its  guests  to  prevent} 
them  from  making  a  noise  when  you  wish  to  rest,' 
and  which  in  fact  has  all  the  conditions  necessary 
for  the  successful  treatment  of  tuberculosis — If  you 
could  find  such  a  place,  you  will  admit  that  it  would' 
be  the  wisest  place  to  which  to  go.  Such  a  hotel; 
is  to  be  found  in  the  modern  sanatorium.  Oh !  but' 
you  would  die  if  you  went  among  so  many  sick 
people !  That  is  where  you  share  a  popular  notion 
which  is  utterly  wrong. 

You  will  be  surprised  to  find  that  the  ma- 
jority of  patients  at  the  sanatorium  seem  to 
think  that  your  condition  is  much  worse  than 
theirs.  Every  tuberculous  patient  thinks  he 
has  less  trouble  than  the  other  fellow.  Further, 
the  patients  you  will  meet  walking  around  the 
sanatorium  are  a  much  healthier  looking  lot  of 


102  THE  BATTLE  WITH  TUBERCULOSIS 

individuals  than  the  average  street-car  load  of 
people  you  see  in  the  city.  Their  faces  are  not 
tired  and  haggard  and  lined  with  care;  their  faces 
are  fat  and  tanned  and  round  and  happy.  To  be 
sure,  if  you  seek  out  the  very  sick  patients  you 
can  find  them  in  their  rooms  or  in  bed  on  their 
porches,  but  so  far  as  associating  with  them  is 
concerned,  that  depends  entirely  on  yourself. 
Strange  to  say,  although  you  think  you  will  die 
from  being  among  so  many  sick  people,  a  week  or 
a  fortnight  will  not  have  been  passed  at  the  sana- 
torium before  you  find  yourself  not  only  seeking 
out  the  sick  man  in  his  sanctum,  but  you  will  be 
acquiring  the  most  valuable  lessons  of  your  life  at 
the  feet  of  this  probable  victim  of  bull-headedness, 
this  doubting  Thomas  who  has  had  to  learn  by  ex- 
perience. 

A  sanatorium  is  more  of  a  hotel  or  boarding- 
school  than  a  hospital.  A  good  library,  a  music- 
room,  very  often  a  billiard- room,  and  a  lecture 
and  concert  hall,  form  a  part  of  many  sanatoria, 
and  that  a  certain  amount  of  the  right  sort  of 
amusement  and  diversion  is  just  as  essential  to  the 
well-being  of  the  patient  as  rest  is  a  fact  that  is 
not  overlooked.  No  special  medicine  is  given.  If 
medicine  cured  tuberculosis,  there  would  not  be,  as 
already  mentioned,  one  death  every  three  minutes 
from  tuberculosis  in  the  United  States  alone. 
Should  you  have  some  acute  trouble,  slich  as  a  very 
bad  pain  in  the  stomach,  of  course,  you  would  be 
given  such  medicine  as  would  correct  that  dis- 
ability, but  the  aim  of  the  sanatorium  is  not  to 


CHOOSING  THE  BATTLEGROUND  103 

give  medicine,  but  to  teach  you  how  to  overcome 
bad  habits,  and  to  acquire  good  ones. 

Where  one's  whole  Hfe  has  been  a  constant  train- 
ing to  be  active,  to  do  things,  it  is  not  easy  to  learn 
to  lie  quiet  day  after  day,  week  after  week,  and 
month  after  month,  especially  when  you  are  feeling 
as  though  you  would  like  to  get  up  and  paint  the 
town  red.  It  is  easier,  however,  to  lie  quiet  when 
everybody  about  you  is  doing  the  same  thing,  and 
when  everybody  is  impressing  on  you  the  great  ne- 
cessity of  so  doing,  than  when  your  friends  are  tell- 
ing you  about  their  numerous  activities,  and  hint- 
ing that  if  you  would  get  up  and  get  out,  you  would 
probably  make  a  recovery  much  sooner  than  by 
weakening  yourself  continually  lying  on  the  bed. 
Many  a  man  is  content  to  lie  outside  and  rest  day 
after  day  if  only  he  has  some  one  to  accompany  him, 
but  it  requires  exceptional  determination  and  an 
iron  will  for  a  man  to  leave  the  family  happily 
conversing  within  doors  and  go  outside  by  himself 
to  a  lonely  couch  in  the  cold,  fresh  air.  At  the 
sanatorium,  when  you  go  out  to  "  chase  the  cure," 
the  family  goes  with  you,  and  you  need  not  be 
alone  unless  you  so  desire. 

At  home,  when  Uncle  Joe  comes  down  from  the 
country,  you  are  naturally  expected  to  be  pleased 
to  see  him  at  any  and  every  hour,  and  his  sensitive- 
ness to  the  cold  will  not  permit  of  his  sitting  in  a 
room  with  the  windows  open.  At  the  sanatorium, 
you  may  enjoy  a  visit  from  Uncle  Joe  just  the 
same,  but  somebody,  other  than  yourself,  has  the 
unpleasant  duty  of  making  him  understand  that 
there  are  certain  hours  at  which  he  may  see  you 


I04  THE  BATTLE  WITH  TUBERCULOSIS 

and  other  hours  at  which  he  may  not.  In  short, 
the  line  of  least  resistance  in  the  home  is  away  from 
a  cure,  and  the  line  of  least  resistance  at  a  sana- 
torium is  towards  a  cure. 

You  have  perhaps  heard  that  the  food  at  a 
sanatorium  becomes  monotonous.  That  depends 
much  more  on  the  patient  than  on  the  food.  Cer- 
tain it  is  that  no  one  menu,  no  matter  how  elabo- 
rate, could  please  every  one  of  fifty  tuberculous 
patients.  About  80  per  cent,  of  all  such  patients 
suffer  from  indigestion  at  some  time  during  the 
course  of  their  disease,  and,  very  naturally,  their 
fancy  for  particular  foods  is  constantly  changing. 
You  must  realize  that  you  are  not  going  to  a 
sanatorium  for  good  things  to  eat,  you  are  going 
to  learn  how  to  win  your  battle.  If  you  keep  that 
in  mind  as  your  all-important  objective,  you  will 
be  content  with  the  variety  of  food  which  best 
helps  you  to  accomplish  your  purpose. 

It  has  been  pointed  out  that  a  doctor's  time  for 
educational  purposes  is  limited.  He  may  spend  a 
half  hour  with  you  on  each  visit,  directing  you 
as  to  what  you  ought  to  do  and  what  you  ought  not 
to  do,  and  if  you  are  like  the  average  patient,  you 
will  have  forgotten  an  hour  later  the  greater  part 
of  what  you  have  been  told.  At  the  sanatorium 
you  will  find  old  veterans  who  have  learned  by 
experience,  and  they  will  continually  educate  you; 
you  will  have  before  your  eyes  the  foolish  man  who 
is  losing  his  battle,  and  you  will  see  why  he  is 
losing  it;  you  will  learn  to  attach  importance  to 
important  s)miptoms,  and  you  will  not  be  filled 
with  terror  by  symptoms  that  are  of  little  signifi- 


CHOOSING  THE  BATTLEGROUND  105 

cance.  You  will  not  exhaust  yourself  with  in- 
decision wondering  what  you  should  do  and  what 
you  should  not  do,  provided,  of  course,  you  do 
not  come  to  the  conclusion  that  you  can  institute 
a  better  program  than  the  one  set  by  the  sanatorium. 
At  home  you  may  be  able  to  work  yourself  up 
into  a  frenzy  over  nothing,  and  so  play  upon  the 
sympathies  of  your  relatives  that  they  think  you 
are  in  imminent  danger  of  dying.  At  the  sana- 
torium such  dramatics  would  be  laughed  at  by 
your  fellow  patients,  and  you  would  be  ashamed 
to  lose  control  of  yourself  before  them.  Strangers 
as  teachers,  and  strangers  as  disciplinarians  are 
very  much  more  effective  than  are  the  members  of 
one's  own  family. 

At  home,  should  anything  serious,  such  as  a  hem- 
orrhage, take  place,  there  is  always  the  risk  of  not 
being  able  to  get  the  doctor.  At  a  sanatorium,  you 
rest  in  the  quiet  assurance  that  should  anything 
suddenly  go  wrong,  there  is  a  doctor  in  the  build- 
ing ready  to  come  to  your  aid,  and,  further,  that 
the  doctor  will  have  at  hand  any  special  instru- 
ments which  may  be  indicated  for  use  in  an 
emergency. 

At  home  your  friends,  with  every  good  inten- 
tion, will  disturb  your  peace  of  mind  by  regard- 
ing you  as  a  menace  to  the  health  of  the  other  mem- 
bers of  your  family.  It  matters  little  whether 
or  not  they  know  anything  about  sanitation,  they 
will  annoy  you  with  foolish  advice  and  see  danger 
in  many  of  your  harmless  actions.  You  will  be 
deeply  embarrassed  when  you  happen  to  bring  up 
sputum  in  their  presence,  and  the  glances  they  cast 


106  THE  BATTLE  WITH  TUBERCULOSIS 

at  your  sputum  cup  will  sorely  tempt  you  to  resort 
to  the  dangerous  practice  of  either  spitting  in  your 
handkerchief  or  swallowing  your  sputum.  There 
is  nothing  of  this  at  a  sanatorium.  There,  every- 
body coughs  and  uses  a  sputum  cup  when  he  feels 
like  it,  and  no  one  has  any  comment  to  make. 

This  makes  you  think  of  another  point.  You 
have  so  little  trouble  that  you  would  not  like  to 
be  reinfected  by  the  other  patients  in  a  sanatorium. 
The  chances  against  infection  or  reinfection  in  a 
sanatorium  are  very  much  less  than  in  your  own 
home,  for  the  simple  reason  that  the  dangers  are 
much  better  understood  by  the  doctors  in  charge 
of  a  sanatorium  than  by  your  friends  and  the 
members  of  your  household.  Moreover,  that  which 
tends  to  cure  tuberculosis  likewise  tends  to  pre- 
vent it.  Dr.  Edward  R.  Baldwin,  of  Saranac  Lake, 
writes  :*  "  No  case  of  tuberculosis  has  been  known 
to  develop  among  the  employees  of  the  Cottage  San- 
atorium since  its  foundation  twenty-two  years  ago. 
These  included  waitresses,  chambermaids,  and 
laundresses,  many  of  whom  were  badly  nourished 
on  entering  the  service.  The  same  absence  of  in- 
fection among  nurses  and  attendants  was  claimed 
by  Dettweiler  of  the  Falkenstein  Sanatorium." 

The  late  Eh*.  E.  L.  Trudeau,  who  was  one  of  the 
greatest  authorities  in  America  on  tuberculosis, 
says :  *  "  There  is  much  less  chance  for  a  suscep- 
tible  individual  to  become  infected   in   a   well- 

^Osler's  "Modern  Medicine,"  vol.  iii,  page  184. 
'  "  A  Directory  of  Institutions  and  Societies  Dealing  with 
Tuberculosis  in  the  United  States  and  Canada,"  page  iv. 


CHOOSING  THE  BATTLEGROUND  107 

planned,  well-directed  sanitorium  than  anywhere 
in  the  ordinary  walks  of  life." 

It  is  a  fact  that  a  man  suffering  from  tubercu- 
losis and  unaware  of  the  presence  of  the  disease  is 
a  much  greater  source  of  danger  than  is  the  recog- 
nized invalid.  When  a  case  of  tuberculosis  is 
discovered  in  the  home,  so  frequently  is  it  found 
that  some  second  or  third  member  of  the  household 
also  has  the  disease  without  knowing  it,  that 
specialists  make  it  a  rule  to  examine  all  members  of 
households  in  which  one  case  of  tuberculosis  is 
discovered.  Another  serious  consideration  is  the 
possibility  of  contracting  secondary  infections,  such 
as  common  colds,  tonsillitis,  influenza,  whooping- 
cough,  and  the  like.  In  the  home  there  is  little 
protection  against  anyone  who  comes  In,  whether 
it  be  the  delivery  boy  or  the  society  "  caller."  Any 
one  of  them  with  whom  you  come  in  contact  may 
chance  to  infect  you  with  something  other  than 
tuberculosis.  Also,  at  home  there  are  the  infected 
street  dust,  the  infection  of  public  conveyances, 
and  the  smoke  of  trains  and  factories,  all  of  which 
dangers,  if  not  entirely  avoided,  are  greatly  reduced 
at  a  suitably  located  sanatorium. 


CHAPTER  XIII 
Campaigning 

Considering  the  convincing  arguments  in  favor 
of  a  sanatorium  as  the  best  ground  on  which  at 
least  to  begin  your  battle  against  the  tubercle 
enemy,  it  is  disappyointing  to  record  that  not  over 
lo  per  cent,  of  tuberculous  patients  enter  sanatoria 
for  education  and  treatment.  What,  however,  is 
infinitely  worse  is  that  almost  80  per  cent,  of  the 
men  and  women  suffering  with  active  tuberculosis 
are  obliged  to  continue  at  work  in  spite  of  their 
disease.  When  you  begin  to  chafe  under  restric- 
tions of  treatment,  consider  for  a  moment  the 
thousands  of  fellow-sufferers  who  would  give 
everything  they  possess  for  the  opportunity  about 
which  you  grumble. 

Notwithstanding  this  terrible  handicap  to  the 
stamping  out  of  the  disease,  the  anti-tuberculosis 
workers  of  England  succeeded  in  bringing  about  in 
forty  years  a  50  per  cent,  reduction  in  the  deaths 
from  tuberculosis,  and  in  New  York  a  40  per  cent, 
decrease  has  been  accomplished  in  sixteen  years. 
The  greatest  factor  in  these  reductions,  according 
to  Dr.  Newsholme,  is  hospitals  and  sanatoria. 

Probably  the  greatest  problem  with  which  the 
majority  of  tuberculous  patients  are  confronted 
is  the  financial  one.  If  you  are  the  breadwinner 
of  the  family,  you  do  not  see  how  you  can  go 
away  and  leave  the  household  to  shift  for  itself. 
108 


CAMPAIGNING  109 

It  may  be  difficult  to  realize  it,  but  it  is  just 
this  course  which  is  the  right  one.  If  to-day  you 
had  been  killed  in  a  street  accident,  what  would 
happen  to  the  members  of  your  family  if,  as  might 
also  happen,  you  had  no  insurance  on  your  life? 
Such  a  tragedy  is  occurring  in  some  home  nearly 
every  day,  and  the  family  is  much  better  able  to 
adjust  itself  to  the  new  conditions  than  if  it  had, 
added  to  its  loss,  the  expense  and  misery  of  taking 
care  of  a  dying  man.  Be  perfectly  honest  with 
yourself  and  be  sure  that  "  What  would  the  family 
do?"  is  not  a  cloak  for  your  own  impulse  and 
desire,  or  an  excuse  for  procrastinating  in  a  con- 
sideration of  the  real  issue.  It  is  better  that  the 
members  of  your  family  should  do  without  you 
for  a  year,  or  even  longer,  than  that  you  should 
become,  for  an  indefinite  period,  a  millstone  of 
infection  and  financial  encumbrance  around  their 
necks.  There  are  many  sanatoria  ready  to  take 
you  for  nothing,  and  remember  that  the  pride  or 
prejudice  which  would  keep  you  from  accepting 
such  an  opportunity  when  you  are  utterly  unable 
to  pay  your  way  is,  in  your  instance,  a  sin  of 
selfishness  which  may  be  the  means  of  sacrificing 
lives  more  precious  and  innocent  than  your  own. 

When  all  is  said  and  done  there  remain  a  majority 
of  tuberculous  individuals  who  cannot  or  will  not 
submit  to  sojourn  in  a  sanatorium.  For  such 
there  have  been  instituted  tuberculosis  dispensaries, 
advice  and  care  stations,  day  and  night  camps, 
visiting  nurses,  etc.  It  is  not  within  the  scope 
of  this  book  to  describe  these  various  schemes,  but 
it  may  be  pointed  out  that  each  has  for  its  object, 


no     THE  BATTLE  WITH  TUBERCULOSIS 

not  the  giving  of  charity,  but  the  education  of  the 
patient,  so  that  he  may  secure  the  best  possible 
resuhs  on  his  own  resources.  It  is  well  that  a 
patient  at  home  who  cannot  afford  a  private  doctor, 
or  whose  doctor  cannot  spare  the  time  required  to 
give  information  on  all  points  pertaining  to  the 
disease,  should  seek  education  early  from  officials 
whose  business  it  is  to  instruct  tuberculous  patients. 
Any  member  of  a  local  anti-tuberculosis  associa- 
tion can  give  directions  as  to  the  proper  place  at 
which  to  apply. 

Suppose  you  have  come  to  the  conclusion  that 
you  wish  to  go  to  a  sanatorium,  and  suppose 
you  can  afford  to  pick  and  choose.  Which  sana- 
torium should  you  select?  There  are  sanatoria 
in  the  frosty  North  and  sanatoria  in  the  sunny 
South;  there  are  sanatoria  near  home  and  others 
far  away;  some  in  high  altitudes  and  some  down 
by  the  seas ;  some  in  wet  climates  and  some  in  the 
arid  plains.  Which  one  offers  you  the  best  prospect 
of  recovery?  That  all  depends  on  your  condition, 
physically,  psychologically,  and  socially.  There  is 
no  one  place  which  offers  distinct  advantages  for 
all  cases  of  tuberculosis,  and  very  often  the  place 
which  is  desirable  for  one  patient  is  absolutely 
contra-indicated  for  another.  Your  doctor  should 
be  the  one  to  advise  on  this  point.  Unfortunately 
many  doctors  know  little  about  localities  other  than 
the  one  in  which  they  dwell,  so  you  wt)uld  be  wise 
to  seek  supplementary  advice  about  the  advantages 
and  disadvantages  of  any  health  resort  in  which 
you  think  of  residing. 

The  majority   of   incipient   tuberculous   cases, 


CAMPAIGNING  in 

provided  they  follow  the  right  treatment,  do  well 
in  practically  any  climate.  There  is  an  occasional 
incipient  case  fated  to  die  from  the  moment  of 
attack  by  the  tubercle  germ,  because  the  individual 
is  lacking  in  the  necessary  resistance.  But  pro- 
vided your  resistance  equals  or  is  above  the 
average,  and  provided  you  can  be  sure  your  trouble 
is  in  its  incipiency,  you  need  not  worry  about  cli- 
mate, but  should  enter  the  best  local  sanatorium. 
Should  you  become  well  enough  to  again  take  up 
your  regular  work,  there  is  a  small  advantage  in 
having  made  a  cure  in  the  locality  in  which  you  are 
going  to  work,  especially  if  that  work  be  manual 
labor,  because  a  readjustment  to  the  climate  will  not 
then  be  required,  nor  will  the  -results  secured  be 
undone  owing  to  a  return  to  more  unfavorable 
weather  conditions. 

Every  one  agrees  that  it  is  unwise  for  a  patient 
who  is  very  ill  with  tuberculosis  to  travel  a  long 
way  from  home.  Of  course,  should  he  be  able  to 
afford  the  best  of  nursing  in  his  travels  and  at  his 
destination,  the  change  may  give  him  much  relief 
from  his  suffering,  and  is  occasionally  accompanied 
by  unexpectedly  good  results.  But  few  tuberculous 
patients  can  afford  such  luxury.  Generally  speak- 
ing, the  patient  who  is  suffering  from  tuberculous 
diarrhoea,  extensive  tuberculous  involvement  of 
the  throat,  marked  shortness  of  breath  with  blue- 
ness  of  the  lips,  extreme  emaciation  and  weakness, 
or  advanced  complications,  such  as  diabetes. 
Bright 's  disease,  etc.,  should  not  go  farther  away 
from  home  than  to  a  local  hospital. 

With  the  exception  of  the  very  far  advanced 


112  THE  BATTLE  WITH  TUBERCULOSIS 

cases  there  are  very  few  tuberculous  individuals 
who  would  not  gain  some  advantage  from  a  change 
to  certain  climates.  If  you  can  afford  to  make  a 
change,  you  would  be  foolish  to  turn  your  back 
on  a  climate  which  has  distinct  advantages  over 
that  in  your  immediate  locality.  Rest,  good  food, 
and  fresh  air  all  come  before  climate  in  importance, 
notwithstanding  that  some  patients  believe  that 
certain  climates  in  themselves  are  sufficient  to  cure 
tuberculosis;  and  that  many  people  in  all  health 
resorts  exaggerate  the  benefits  conferred  by  the 
weather  conditions  of  their  particular  resorts. 
Many  cases  recover  in  very  poor  weather  condi- 
tions, and  you  will  find  some  doctors  who  declare 
that  there  is  no  advantage  whatever  in  climate. 

Aside  altogether  from  complex  scientific  con- 
siderations, ask  yourself  the  following  questions : 
"  On  which  days  am  I  more  likely  to  follow  the  out- 
of-doors  treatment — clear  days  or  rainy  days,  dark 
days  or  bright  days,  calm  days  or  stormy  days?" 
"  On  which  days  are  my  spirits  the  more  buoyant — 
happy,  sunshiny  days,  or  gloomy,  cloudy  and  wet 
days?"  "On  which  days  do  I  have  the  better 
appetite — when  the  perspiration  trickles  down  my 
face,  or  when  I  can  appreciate  a  light  wrap?" 
"  When  do  I  make  the  best  progress — when  hu- 
midity melts  my  collar  into  a  rag,  or  when  a  slight 
tang  in  the  air  stimulates  my  every  organ  to  activ- 
ity? "  "  On  which  days  do  I  most  feel  the  joy  of 
living — when  the  smoke  turns  a  somersault  over 
the  side  of  the  chimney,  or  when  it  rises  like  a 
fluffy  pillar  straight  up  into  the  blue  of  heaven?  " 

The  climate  which  offers  more  sunshine  and  less 


CAMPAIGNING  113 

cloud  and  rain,  more  calm  and  less  storm,  greater 
dryness  and  less  humidity,  and  the  climate  which 
offers  a  more  equable  barometric  pressure  than  that 
of  your  home,  obviously  offers  advantages  which 
are  not  afforded  there.  No  climate  is  perfect;  it 
is  only  relatively  better  than  another  climate,  and 
very  often  you  will  find,  shortly  after  your  arrival 
in  any  health  resort  which  is  noted  for  its  wonder- 
ful climate,  that  there  comes  a  quite  unprecedented 
period  of  inclement  weather. 

There  is  one  great  group  of  health  resorts,  how- 
ever, which  is  preeminent  in  the  advantages  it  has 
to  offer  the  tuberculous  invalid.  This  is  the  group 
which  is  situated  in  high  altitudes.  High  altitudes 
vary  from  4000  to  7000  feet  above  sea  level,  and 
the  most  famous  resorts  are  to  be  found  in  the 
Alps,  the  Rockies  and  the  Andes.  The  Alps  are  the 
coldest  and  have  the  greatest  precipitation  of  snow. 
The  Rockies  have  more  sunshine  and  the  accommo- 
dation is  less  expensive,  but  at  the  same  time  there 
is  more  wind  and  dust.  The  opportunities  for 
employment  are  better  in  the  Rockies,  but  in  nearly 
every  health  resort  wages  are  discounted  owing 
to  the  great  number  of  transients  and  newcomers 
looking  for  positions.  Some  people  are  precluded 
from  high  altitude  resorts,  owing  to  heart  or  kidney 
trouble,  or  a  physical  condition  which  will  not  react 
to  the  marked  stimulus  of  the  rare  atmosphere. 
Consequently  it  is  always  advisable  to  ascertain  be- 
fore leaving  home  that  there  is  nothing  in  your 
physical  condition  incompatible  with  the  new  Con- 
ditions. 

High  altitudes  are  characterized  by  rarity  of 
8 


114    THE  BATTLE  WITH  TUBERCULOSIS 

atmosphere,  and  this  condition  stands  first  among" 
cHmatic  factors  in  its  helpfulness  to  tuberculous 
invalids.  The  rarity  of  air  causes  deepened  breath- 
ing, so  that  areas  in  the  lung,  which  in  low  alti- 
tudes remain  unused  and  catarrhal,  become,  in  high 
altitudes,  ventilated  and  reinvigorated.  Children 
born  and  brought  up  in  high  altitudes  have  on  an 
average  larger  chests  than  other  children,  and  the 
number  of  cases  of  tuberculosis  developing  in  high 
altitudes  is  relatively  small. 

The  second  condition  of  great  value  to  tuber- 
culous individuals  in  high  altitudes  is  the  dryness. 
It  is  a  fact  that  people  in  high  altitudes  drink  more 
water  because  the  water  from  the  body  is  so  readily 
taken  up  by  the  atmosphere.  This  means  that 
there  takes  place  a  greater  flushing  of  impurities 
from  the  body,  and  at  the  same  time  there  is  less 
perceptible  perspiration.  So  quickly  is  moisture 
taken  up  that,  at  an  altitude  of  six  thousand  feet, 
it  is  no  unusual  thing  to  see  the  snow  disappear  as 
if  by  magic  without  wetting  the  dust  beside  which 
it  lies.  A  high  degree  of  humidity  is  a  great  handi- 
cap to  the  majority  of  tuberculous  people,  and,  as 
may  be  seen  by  a  glance  at  a  weather  chart,  the 
relative  humidity  of  high  altitudes  is  exceedingly 
low. 

Illumination  and  atmospheric  electricity  is  the 
third  factor  in  the  climate  of  high  altitudes  which 
renders  it  valuable  to  health  seekers.  People  are 
generally  inclined  to  consider  sunshine  the  most 
important  factor  in  estimating  the  advantages  of 
a  climate,  but,  important  as  sunshine  is  in  tuber- 
culosis, it  takes  a  place  second  to  rarity  and  dry- 


CAMPAIGNING  115 

ness  of  atmosphere.  It  is  found  that  the  blood 
of  the  great  majority  of  patients  going  to  high 
altitudes  shows  a  remarkable  improvement  in  rich- 
ness shortly  after  the  patient's  arrival.  The  blood- 
pressure,  contrary  to  popular  belief,  is  at  first 
lowered,  and,  as  the  patient  becomes  acclimated,  is 
slightly  raised,  owing  to  the  increased  strength  of 
the  heart  muscle.  A  patient  is  not  more  liable  to 
lung  hemorrhages  in  high  altitudes,  and  in  fact 
many  hemorrhagic  cases  have  fewer  hemorrhages 
after  going  from  a  low  to  a  high  altitude. 

Regarding  psychological  considerations,  there 
are  unfortunately  too  many  patients  who  have 
never  learned  what  it  is  to  exercise  self-control. 
They  seem  to  be  utterly  unable  to  make  themselves 
follow  anything  resembling  a  rest  cure.  Should 
any  such  go  to  a  high  altitude  they  will  doubtless 
run  themselves  to  death  much  more  rapidly  than 
if  they  had  stayed  at  home.  It  is  folly  to  make  the 
expenditures  necessary  for  a  long  trip  on  patients 
of  this  character,  as  there  can  be  only  one  termina- 
tion to  their  condition.  There  is  also  another  group 
of  cases — those  who  have  been  over-protected  at 
home,  and  whose  sensitiveness  and  tenderness  are 
such  that  life  anywhere,  except  in  the  bosom  of 
their  own  families,  would  be  intolerable.  In  such 
cases  the  advantages  of  climate  or  altitude  would 
be  more  than  offset  by  the  great  disadvantage  of 
continual  fretting. 

The  social  considerations  are  chiefly  those  of 
financial  support.  It  is  foolish  for  a  tuberculous 
patient  to  consider  a  long  journey  to  a  health 
resort,  unless  he  intends  to  stay  at  least  six  months, 


Ii6  THE  BATTLE  WITH  TUBERCULOSIS 

and  has  $250  outside  of  his  travelHng  expenses 
with  which  to  finance  his  visit.  Plenty  at  home  in 
a  poor  cHmate  is  much  to  be  preferred  to  poverty 
away  in  a  perfect  climate.  To  lie  week  after  week 
in  a  sanatorium,  worrying  for  fear  that  the  next 
month's  check  will  not  materialize,  is  to  incur  a 
handicap  that  has  cost  many  a  good  man  his  life. 
The  patient  who  has  a  small  sum  saved  up,  and  who 
can  follow  the  treatment  only  until  his  money  is 
exhausted,  should  not  invest  his  all  in  climate,  but 
should  conserve  his  savings  for  the  maximum 
amount  of  rest,  fresh  air  and  good  food  at  or  near 
his  home. 

If  you  have  the  necessary  funds  to  go  to  a  health 
resort,  choose  one  which  is  frankly  recognized  as 
good  for  tuberculosis,  and  go  with  the  earnest  pur- 
pose of  fighting  your  disease.  A  fashionable 
pleasure  resort  in  the  season  is  worse  than  useless 
for  the  man  or  woman  with  tuberculosis,  and  to 
go  to  any  resort  where  you  are  tempted  to  try  and 
hide  your  condition  is  utter  folly. 


CHAPTER  XIV 
The  Orders  for  the  Day 

Every  invalid  should  make  it  an  invariable  rule 
not  to  leave  a  known  location  for  an  unknown  one, 
without  having  ascertained  as  far  as  possible  the 
conditions  that  will  be  encountered  at  the  end  of 
the  journey.  Much  uncertainty  will  be  overcome  if 
a  sanatorium  is  the  destination,  but  sanatoria  differ 
in  kind,  just  as  widely  as  their  superintendents 
differ  in  ability.  A  well-equipped  sanatorium 
should  have  one  or  more  resident  doctors  who 
devote  their  entire  time  to  the  treatment  of  tuber- 
culosis. As  a  part  of  the  institution  there  should 
be  an  infirmary  where  patients  may  be  given  proper 
nursing  in  emergencies,  or  when  complications 
arise.  There  should  also  be  an  X-ray  equipment  and 
modern  apparatus  for  controlling  hemorrhage. 

When  you  enter  a  sanatorium  as  a  patient,  your 
history  should  be  taken  and  your  chest  examined; 
examinations  should  also  be  made  of  your  sputum, 
blood,  urine,  blood-pressure,  and  an  X-ray  picture 
taken  of  your  chest.  You  should  be  taught  to  keep 
a  chart  of  your  own  condition,  and  this  chart  should 
be  inspected  once  a  week  by  one  of  the  doctors  of 
the  institution.  Monthly  examinations  should  be 
made  of  your  chest. 

By  sending  fifty  cents  to  the  Secretary  of  the 
National  Association  for  the  Study  and  Prevention 

117 


ii8  THE  BATTLE  WITH  TUBERCULOSIS 

of  Tuberculosis,*  you  may  secure  a  "  Directory  to 
Sanatoriums  in  the  United  States  and  Canada," 
which  will  give  you  a  complete  choice  and  reliable 
information  about  each  institution.  You  may  se- 
cure further  information  by  applying  for  circulars 
to  the  sanatorium  or  sanatoria  in  which  you  are 
interested. 

Where  your  destination  is  not  a  sanatorium,  the 
information  to  be  ascertained  before  departure 
presents  more  difficulties.  The  first  question  is, 
.Where  are  you  going  to  stay  ?  Perhaps  you  think 
you  will  register  at  a  hotel  until  such  time  as  you 
get  an  opportimity  to  look  around  for  a  suitable 
boarding-house.  If  it  can  possibly  be  avoided,  you 
should  not  set  out  under  any  such  an  indefinite  ar- 
rangement. It  is  essential  that  the  first  thing  you  do 
on  arrival  at  your  destination  is  rest.  Especially 
is  this  indicated  if  you  are  going  to  a  high  altitude, 
as  there  the  work  imposed  on  your  heart  is  very 
much  greater  than  it  is  at  home,  until  such  time 
as  you  become  acclimated,  which  may  take  from 
two  weeks  to  a  month.  The  stimulus  to  undertake 
much  exercise  and  a  feeling  of  greater  endurance 
is  very  marked  in  a  high  altitude,  and  more  than 
once  it  has  happened  that  a  weakened  individual 
has  undertaken  so  much  exercise  on  the  first  few 
days  after  arrival  that  he  has  suddenly  expired 
owing  to  acute  dilatation  of  the  heart.  While  such 
a  disaster  is  infrequent,  it  is  no  uncommon  thing 
for  a  patient  to  so  overtax  himself  on  arrival  in  a 
health  resort  that  his  period  of  illness  is  thereby 
lengthened  by  several  months. 

*  105  East  22nd  Street,  New  York  City. 


THE  ORDERS  FOR  THE  DAY  119 

If  possible,  get  in  touch  by  correspondence  with 
somebody  in  the  town  to  which  you  intend  to  travel. 
It  the  town  has  a  sanatorium,  you  will  probably 
be  able  to  get  information  regarding  a  place  at 
which  to  stay  through  this  source,  as  every  sana- 
torium has  a  list  of  boarding-houses  to  which  it 
sends  ex-patients  or  patients  who  are  waiting  for 
admission.  The  disadvantages  of  most  boarding- 
houses  are  their  uncertainties.  It  is  uncertain 
what  the  character  of  your  room  will  be  and 
whether  or  not  it  has  been  properly  disinfected. 
You  cannot  be  certain  whether  or  not  the  eating 
utensils  are  boiled  after  each  meal,  whether  or  not 
you  will  come  in  contact  with  careless  consump- 
tives, and  whether  or  not  the  food  will  be  of  the 
right  character  and  properly  cooked.  You  can- 
not be  certain  as  to  who  will  look  after  your  needs 
in  case  you  should  have  to  go  to  bed  for  some  days 
or  weeks.  And  there  are  many  other  uncertainties. 
For  these  reasons,  and  also  on  account  of  restless- 
ness, some  patients  develop  a  wanderlust,  and  con- 
tinual changing  becomes  a  habit.  An  occasional 
change  in  the  same  locality  is  a  very  good  thing  for 
tuberculous  patients,  but  when  changes  are  made 
too  frequently,  one  is  continually  unsettled  in  mind 
and  body,  and  such  a  condition  is  incompatible  with 
good  progress.  When  the  change  involves  a  dif- 
ferent climate  or  different  altitude,  it  is  much  more 
serious,  and  too  much  care  cannot  be  exercised  in 
limiting  as  far  as  possible  the  frequency  of  such 
changes.  They  involve  a  complete  physiological 
readjustment,  and  while  the  readjustment  is  in 


I20  THE  BATTLE  WITH  TUBERCULOSIS 

progress  the  forces  of  defence  are  much  more 
vulnerable  to  attack. 

Who  is  going  to  be  your  medical  adviser  in  the 
new  location?  Perhaps  your  home  doctor  has 
promised  to  send  you  by  letter  any  advice  you  may 
require,  or  perhap^s  you  consider  that  you  will  need 
no  further  advice  on  a  subject  about  which  you 
have  become  more  or  less  a  specialist.  Not  only 
should  you  have  a  doctor  at  your  destination,  but 
you  should  consult  him  immediately  on  your  ar- 
rival. Neither  you  nor  your  home  doctor  can 
possibly  take  into  accoimt  all  the  important  con- 
siderations of  altered  conditions  at  your  destina- 
tion, and  to  get  started  right  in  new  conditions  is 
half  the  battle.  Further,  your  physical  condition 
in  a  month,  or  even  a  week  hence,  may  be  very 
different  from  what  it  is  to-day,  and  if  you  are 
to  make  an  accurate  estimate  of  the  advantages  or 
disadvantages  of  the  new  location,  it  is  necessary 
that  your  doctor  should  have  a  picture  of  your 
chest  condition  at  the  time  of  your  arrival,  in  order 
to  make  comparisons  at  a  later  date.  If  possible, 
have  your  home  doctor  give  you  a  letter  of  intro- 
duction to  some  doctor  at  your  destination  whom 
he  can  recommend.  It  is  criminal  for  a  doctor 
to  send  a  patient  away  from  home  with  the  advice 
to  live  out-of-doors,  to  exercise  freely,  and  to 
consult  no  physician. 

Is  the  weather  settled  at  your  destination? 
Owing  to  the  greater  vulnerability  of  your  forces 
of  defence  during  the  readjustment  following  the 
change  to  another  climate,  it  is  well  that  you  should 


THE  ORDERS  FOR  THE  DAY  121 

choose  for  travel  a  season  of  the  year  that  will 
ensure  comparatively  settled  weather  conditions  in 
the  new  locality  to  which  you  journey.  Even  in 
the  best  of  climates  there  is  liable  to  be  a  rainy 
or  stormy  season,  and  it  is  well  to  avoid  initiation 
into  weather  conditions  at  such  a  season.  If  by 
chance  you  have  had  a  hemorrhage,  travelling  of 
any  kind  should  be  postponed  for  at  least  two 
weeks  after  the  hemorrhage  has  taken  place. 

A  question  regarding  your  hand-baggage  which 
may  seem  to  you  trivial  is,  "  Do  you  intend  to 
carry  it  yourself?"  The  question,  however,  in- 
volves and  illustrates  very  well  the  principle  of 
true  as  opposed  to  false  economy.  There  are  a 
great  many  things  with  respect  to  which  you  may 
conserve  your  money  with  benefit,  but  where  your 
own  precious  strength  is  sacrificed  in  return,  the 
economy  is  false  and  is  in  reality  an  extravagant 
investment.  To  carry  your  own  dress-suit  case  or 
valise  in  order  to  save  fifty  cents  on  baggage  trans- 
fer, through  the  extra  time  you  will  spend  in  re- 
covering from  the  effects  of  the  indiscretion,  quite 
possibly  may  cost  you  fifty  dollars  in  the  long  run. 
In  the  same  category  there  are  many  false 
economies,  such  as  sitting  up  all  night  while  travel- 
ling in  order  to  save  the  Pullman  fare,  economizing 
on  meals  at  a  time  when  increased  exertion  de- 
mands extra  nourishment,  or  walking  from  the 
station  in  order  to  save  carfare  or  the  expense  of 
a  cab. 

When  you  arrive  at  a  sanatorium  or  boarding- 
house,  do  not  immediately  start  in  to  unpack  all 


122  THE  BATTLE  WITH  TUBERCULOSIS 

your  belongings.  Postpone  that  for  a  few  days, 
and  when  you  do  undertake  it,  limit  yourself  to 
a  definite  time.  You  have  many  days  before  you 
to  straighten  up  your  room,  and  if  you  arrange 
to  undertake  this  work  definitely  from  ii  to  11.15 
o'clock  each  morning,  it  will  soon  be  accomplished 
without  evil  effects. 

At  a  sanatorium  you  will  find  the  orders  for 
the  day  are  somewhat  as  follows : 

7.00  A.M. — Rise,  wash  and  dress.  Sometimes,  if  it  be  desired, 
a  glass  of  milk  or  cup  of  coffee  is  served  before  rising. 
If  a  patient  is  not  too  weak,  the  back  and  chest  should  be 
sponged  with  cold  water  and  the  skin  should  be  made  to 
glow  with  a  rough  towel.  The  stronger  patients  some- 
times take  a  cold  shower  or  a  cold  plunge  bath,  but  this 
involves  a  degree  of  exercise  which  it  is  not  well  to 
undertake  without  special  permission.  The  habit  some 
patients  have  of  lying  in  bed  until  the  last  moment,  and 
then  dressing  in  a  great  hurry,  is  both  foolish  and  risky. 

8.00  A.M. — Breakfast.  Eat  slowly  and  chew  your  food  thor- 
oughly. If  you  have  pleasant  table  companions  and  a 
cheerful  conversation,  so  much  the  better  for  your  diges- 
tion. 

8.30  A.M. — Evacuation  of  the  bowels.  This  important  detail 
should  be  attended  to  just  as  regularly  as  any  other  item 
of  the  program. 

8.45  A.M. — Lying  down  outside  on  the  porch  or  completely 
out  of  doors. 

10.00  A.M. — Exercise  when  it  has  been  definitely  ordered. 
Never  take  it  on  yourself  to  regulate  your  own  exercise, 
as  this  is  the  most  vital  matter  in  the  treatment  of  the 
disease.  For  at  least  the  first  two  weeks  at  the  sanatorium 
you  will  receive  no  permission  to  exercise,  and  do  not 
allow  anybody,  even  although  he  appears  to  know  more 
about  it  than  the  doctor,  to  tempt  you  from  your  regime 
of   complete   rest. 

10.30  A.M. — If  it  be  desired,  a  small  luncheon  of  a  glass  of 
milk  and  crackers,  or  beef-juice,  or  raw  eggs,  may  be 
served,  and,  provided  it  in  no  way  interferes  with  three 
good  meals  a  day,  such  a  luncheon  is  sometimes  an 
advantage. 


THE  ORDERS  FOR  THE  DAY  123 

11.30  A.M. — Silent  rest  hour.  This  means  lying  down  in  the 
fresh  air  away  from  everybody  else.  There  is  to  be  no 
talking,  reading,  or  activity  of  any  kind.  Probably  no 
one  factor  in  the  treatment  of  tuberculosis  is  as  helpful 
as  the  silent  rest  hours,  provided  they  are  carried  out  to 
the  letter.  You  should  make  yourself  comfortable  by 
removing  such  portions  of  your  clothing  as  you  feel 
constricting. 

12.30  P.M. — Wash  and  dress. 

i.oo  P.M. — Dinner. 

2.00  P.M. — Lie  down  outside  for  one  hour.  If  you  are  able 
to  sleep  in  the  day  time,  take  full  advantage  of  this  rest 
hour.  Many  patients  obtain  great  advantage  by  undress- 
ing and  going  to  bed,  and  for  this  reason  some  sanatoria 
omit  the  morning  silent  rest  hour  and  have  two  hours  of 
silent  rest  directly  after  dinner.  To  the  patient  who  can- 
not sleep,  these  two  hours  of  silent  rest  are  apt  to  become 
so  monotonous  that  he  makes  the  grave  error  of  succumb- 
ing to  a  novel  or  the  newspaper. 

3.30  P.M. — Lunch  of  the  same  character  as  at  10.30  a.m.  if 
desired. 

4.00  P.M. — Exercise  only  when  ordered. 

4.4s  P.M. — Silent  rest  hour  corresponding  to  the  one  before 
dinner. 

5.45  P.M. — Wash  and  dress. 

6.00  P.M. — Supper. 

6.30  P.M. — Outside  until  bedtime. 

9.00  P.M. — To  bed. 

9.30  P.M. — Lights  out. 

Once  or  twice  a  week  a  warm,  cleansing  bath,  followed  by 

a  cold  sponge. 

It  will  be  noticed  that  from  10.00  to  11.30  a.m., 
from  3.00  to  4.45  P.M.,  and  from  6.30  p.m.  until 
bedtime,  there  is  no  standing  order  for  all  patients 
to  rest  During  these  times  many  of  the  patients 
sit  around  talking  outside  or  on  each  other's 
porches.  The  rest  hours,  as  outlined,  are  the 
minimum  that  must  be  followed  by  all  patients,  but 
beyond  this  point  there  are  periods  of  rest  for 
different  patients,  varying  in  duration  from  the 
hours  stated  to  absolute  rest,  which  means  staying 
in  bed  all  of  the  time.     Patients  on  absolute  rest 


124  THE  BATTLE  WITH  TUBERCULOSIS 

are  for  the  most  part  taken  care  of  in  the  Infirmary. 
Their  orders  for  the  day  are  somewhat  as  follows : 

7.00  A.M. — Wash  hands  and  face  or  be  washed  by  the  nurse. 

8.00  A.M. — Breakfast  in  bed. 

10.00  A.M. — Nurse  gives  alcohol  rub  (equal  parts  of  pure 
alcohol  and  water).  Either  the  front  or  the  back  of  the 
body  or  one  limb  only  is  exposed  at  one  time  until  each 
area  is  rubbed  with  alcohol  and  dried  with  a  brisk  rub 
from  a  Turkish  towel. 

10.30  A.M. — Beef  juice  (two  cmnces  with  a  biscuit)  or  other 
nourishment. 

11.30  A.M. — Silent  rest  hour. 

12.30  P.M. — Wash  hands. 

i.oo  P.M. — Dinner  in  bed. 

3.30  P.M. — Beef  juice  and  cracker. 

4.45  P.M. — Silent  rest  hour. 

5.45  P.M. — Wash  hands. 

6.00  P.M. — Supper. 

8.00  P.M. — Alcohol  rub  by  nurse. 

9.00  P.M. — ^Lights  out. 

The  nurse  gives  a  cleansing  sponge  bath  once  a  week,  pro- 
vided the  patient  is  too  weak  to  take  a  warm  plunge  bath 

himself. 

During  your  first  week  or  two  at  the  sanatorium 
you  will  find  many  little  things  which  tend  to  inter- 
fere with  your  main  objective,  but  much  depends 
upon  your  making  a  proper  beginning.  Even  if 
you  are  lonely,  do  not  be  too  pressing  in  your  in- 
vitations to  other  patients  to  visit  you  in  your  room 
or  on  your  porch.  The  time  will  soon  come  when 
•you  will  appreciate  a  place  of  privacy,  and  you 
may  then  find  it  difficult  to  have  your  room  to  your- 
self. The  great  out-of-doors  is  the  best  reception 
room,  where,  at  the  right  hours,  there  will  generally 
be  found  all  the  company  you  desire.  You  will  find 
there  is  a  decided  tendency  for  conversation  to 
become  centred  on  the  disease  from  which  you 
suffer,  and  for  every  patient  to  give  all  the  weary 


THE  ORDERS  FOR  THE  DAY  125 

details  of  his  "  case."  When  you  are  tempted  to 
tell  your  experiences  with  tuberculosis,  remember 
how  it  bored  you  to  listen  to  the  other  fellow,  and 

"  Talk  health  !  The  dreary,  never-changing  tale 

Of  mortal  maladies  is  worn  and  stale. 

You  cannot  charm  or  interest  or  please 

By  harping  on  that  minor  chord,  disease. 

Say  you  are  well,  or  all  is  well  with  you, 

And  God  shall  hear  your  words,  and  make  them  true."  * 

The  great  majority  of  patients  soon  become 
specialists  in  the  treatment  of  tuberculosis,  and  not 
a  few  appear  to  come  to  the  conclusion  that  they 
know  much  more  about  it  than  the  doctor.  These 
will  tell  you  how  it  is  that  the  orders  for  the  day 
are  based  only  on  theory,  and  that  it  is  not  expected 
of  you  to  follow  them  literally.  Further,  when  you 
do  follow  the  treatment  as  it  should  be  followed, 
you  will  find  that  a  few  of  these  feeble-minded 
individuals,  lacking  the  self-control  to  play  the 
game  themselves,  wisely  smile,  and  wink,  and  per- 
haps get  off  a  little  joke  at  your  expense.  Turn  a 
deaf  ear  and  a  blind  eye  on  all  such  folly,  and 
remember  that  not  only  have  the  orders  for  the 
day  been  drafted  by  the  wisest  physicians  in  the 
world,  but  experience  has  proved  that  they  have 
to  be  acted  upon  and  faithfully  followed  if  you 
would  win  your  battle  against  the  tubercle  enemy. 
As  Marcus  Aurelius  says,"  If  thou  workest  at  that 
which  is  before  thee,  following  right  reason  seri- 
ously, vigorously,  calmly,  without  allowing  any- 
thing else  to  distract  thee,  but  keeping  thy  divine 

*  By  Ella  Wheeler  Wilcox. 


126  THE  BATTLE  WITH  TUBERCULOSIS 

part  pure,  as  if  thou  shouldst  be  bound  to  give  it 
back  immediately;  if  tiiou  boldest  to  this,  expect- 
ing nothing,  fearing  nothing,  but  satisfied  with 
thy  present  activity  according  to  nature,  and  with 
heroic  truth  in  every  word  and  sound  which  thou 
utterest,  thou  wilt  live  happy.  And  there  is  no 
man  who  is  aHe  to  prevent  this." 


PART  TWO 

CHAPTER  XV 
Commandeering  the  Home 

There  are  one  million  tuberculous  patients  in 
the  United  States,  and  only  six  hundred  sanatoria, 
with  thirty-five  thousand  beds,  in  which  to  take 
care  of  them.  Thus  the  vast  majority  of  patients 
must  fight  their  battle  at  home.  While  the  home 
under  ordinary  conditions  offers  serious  handicaps 
to  the  patient's  favorable  progress,  provided  the 
family  can  be  induced  to  adjust  conditions  to  the 
invalid's  needs,  it  is  quite  possible  to  make  the 
home  offer  to  the  tuberculous  patient  more  advan- 
tages than  a  modern  sanatorium. 

If  the  tuberculosis  battle  is  to  be  successfully 
waged  at  home,  it  is  necessary  that  the  home  be 
modelled  on  a  sanatorium  plan,  and  that  the  orders 
for  the  day  be  carried  out  even  more  carefully  than 
at  a  sanatorium.  The  greatest  handicap  to  the 
patient  at  home  arises  from  the  interference  and 
advice  of  friends  and  relatives.  The  majority  of 
people  cannot  comprehend  how  it  is  that  a  man 
can  look  better  than  any  member  in  his  family, 
how  It  is  that  he  can  walk  about  and  go  on  an 
occasional  picnic  or  outing  of  some  kind,  and  yet 
be  fighting  a  life-and-death  struggle.  Tuberculosis 
is  one  disease  in  which  the  inexperienced  must  ac- 
cept without  question  the  statements  of  the  doctor. 

127 


128  THE  BATTLE  WITH  TUBERCULOSIS 

If  la  patient  is  to  stay  at  home  and  fight  his 
battle  successfully,  he  may  do  so  only  on  the  clear 
understanding  that  no  matter  what  he  thinks,  and 
no  matter  what  his  relatives  think  or  say,  the 
doctor's  word  is  law  and  must  be  carried  out  to 
the  letter.  Further,  no  matter  how  alluring  the 
arguments  of  kind,  interfering  relatives  may  be, 
the  members  of  the  patient's  immediate  family 
must,  through  thick  and  thin,  protect  the  patient, 
and  be  loyal  to  the  doctor.  It  must  also  be  real- 
ized that  this  is  not  a  battle  of  days  or  weeks  or 
even  months ;  it  is  probably  a  battle  of  years.  The 
doctor  cannot  tell  you  how  long  it  will  be,  and  the 
unsettled  frame  of  mind,  which  is  continually  ques- 
tioning as  to  when  a  return  to  work  will  be  possible, 
is  most  p>ernicious.  When  the  disease  is  first  dis- 
covered, settle  down  with  the  determination  to 
give  it  a  definite  period,  and  then  proceed  to  live 
one  day  at  a  time,  and  to  make  that  day  count 
for  all  it  is  worth.  If  the  doctor  should  liberate 
you- before  the  time  you  had  fixed  has  arrived,  so 
much  the  better,  but  hope  continually  deferred  not 
only  makes  your  own  heart  sick,  but  so  upsets  the 
members  of  the  family  that  they  are  constantly 
coming  to  the  conclusion  that  they  "  must  do  some- 
thing," such  as  change  the  doctor,  change  the 
treatment,  or  make  some  other  equally  foolish 
alteration. 

If  it  can  be  arranged,  a  move  should  be  made 
to  a  more  favorable  location.  A  change  to  the 
country,  or  at  least  to  the  suburbs  of  the  city,  is 
wise.  There  the  patient  will  be  withdrawn  from 
the  environment  under  which  he  contracted  the 


COMMANDEERING  THE  HOME  129 

disease,  and  the  nearer  the  country  the  less  there 
will  be  of  dust,  smoke  and  infection.  If  a  locality 
can  be  chosen  where  there  is  not  too  much  traffic, 
and  too  many  people  passing  the  house,  the  patient's 
natural  sensitiveness  about  being  stared  at  will 
be  undisturbed.  It  is  well  to  realize,  however,  that 
if  one  cares  more  about  the  staning  and  curiosity 
of  people  than  about  following  the  "  cure,"  the 
chances  of  recovery  will  be  considerably  reduced. 
A  little  change  in  locality  is  often  stimulating  to 
the  patient's  appetite  and  digestion,  and  so  im- 
portant is  it  that  some  doctors  claim  that  a  change, 
even  if  it  be  from  a  good  to  a  bad  climate,  is  of 
advantage. 

The  great  importance  of  environment,  for  the 
man  in  whom  tuberculosis  has  disclosed  itself,  is 
well  illustrated  in  the  classical  experiment  of  the 
late  Dr.  E.  L.  Trudeau.  Taking  fifteen  healthy 
rabbits,  he  divided  them  into  three  divisions.  A, 
B  and  C,  each  consisting  of  five  rabbits.  He  in- 
oculated each  rabbit  of  divisions  A  and  B  with 
tubercle  germs,  and  then  put  division  A  (inocu- 
lated rabbits)  to  live  under  the  best  of  conditions. 
Division  B  (inoculated  rabbits)  and  Division  C 
(healthy  rabbits)  he  put  to  live  under  conditions 
of  privation  and  pwor  sanitation.  Of  the  five 
tuberculous  rabbits  in  Division  A,  four  quite  re- 
covered their  health.  Of  the  five  tuberculous 
rabbits  in  Division  B,  four  died  within  three 
months,  while  none  of  the  five  healthy  rabbits  in 
Divison  C  died.  All  of  this  means  that  while 
healthy  people,  like  healthy  rabbits,  may  flourish 
under  bad  hygienic  conditions,  tuberculous  people, 
9 


130  THE  BATTLE  WITH  TUBERCULOSIS 

like  the  inoculated  rabbits,  die  under  such  con- 
ditions. The  four  recoveries  among  the  five  tuber- 
culous rabbits  which  lived  under  the  best  hygienic 
conditions  should  greatly  encourage  effort  to  per- 
fect conditions  in  the  home  of  tuberculous  patients. 

In  choosing  a  house,  remember  that  regard 
should  be  given  to  outside  considerations,  even 
more,  perhaps,  than  to  inside.  The  patient  will 
probably  spend  four-fifths  of  his  time  out-of-doors, 
and  if  he  carries  out  this  part  of  his  treatment 
properly,  the  inside  of  the  house  is  a  matter  of 
secondary  consideration.  An  ideal  location  for 
a  house  is  to  have  it  standing  back  from  the  street, 
on  an  elevation  of  three  hundred  to  seven  hundred 
feet,  and  with  a  sunny  exposure.  An  old  Indian 
proverb  says,  "  He  who  plants  a  tree  in  front  of 
his  house  begins  to  dig  his  own  grave."  Remem- 
ber that  there  is  no  better  disinfectant  than  sun- 
light. The  house  should  have  one  or  more  porches, 
or,  at  least,  a  favorable  position  on  its  south  side 
for  the  building  of  a  porch.  There  are  very  few 
houses,  even  in  the  heart  of  a  great  city,  which 
will  not  permit  of  the  construction  of  a  small 
veranda  where  a  patient  may  sleep  in  the  fresh  air.* 

A  porch  on  the  north  as  well  as  the  south  offers 
additional  comfort  to  the  patient  in  the  heat  of 
summer.  If  possible,  the  patient's  dressing-room 
should  be  in  connection  with  this  porch.     If  the 

*  In  the  free  literature  sent  out  by  the  National  Associa- 
tion for  the  Study  and  Prevention  of  Tuberculosis,  there  are 
some  excellent  cuts  which  illustrate  ways  and  means,  and  for 
a  more  thorough  consideration  of  the  subject  Dr.  Thomas 
Specs  Carrington's  book,  "  Fresh  Air  and  How  to  Use  It," 
may  be  purchased  for  one  dollar  from  the  Association. 


COMMANDEERING  THE  HOME  131 

door  between  the  two  can  be  made  sufficiently 
wide  to  permit  of  a  bed  being  wheeled  in  and  out 
as  desired,  this  is  a  great  advantage,  especially  in 
the  case  of  a  very  sick  patient. 

An  ideal  room  is  one  that  measures  at  least 
12  X  14  X  10  feet;  the  windows  and  balcony  door 
should  have  an  area  of  at  least  one-seventh  of  the 
floor  space ;  it  should  be  possible  to  flood  the  room 
with  sunlight ;  the  floors  should  be  of  polished  hard- 
wood or  covered  with  linoleum;  the  walls  should 
be  covered  with  washable  paper  or  paint;  there 
should  be  no  ledges  and  the  corners  should  be 
rounded;  a  fireplace  is  a  disadvantage  in  so  far 
as  it  causes  dust,  but  if  kept  properly  clean,  is 
valuable  in  the  additional  ventilation  it  affords; 
the  heating  should  be  by  hot  water  or  steam ;  a  gas 
heater  or  oil  stove  should  be  absolutely  prohibited ; 
if  a  hot-air  flue  enters  the  room,  it  should  be  kept 
closed  while  the  room  is  occupied  by  the  patient. 

Where  funds  are  limited,  they  should  be  de- 
voted chiefly  to  making  the  porch  comfortable,  and 
also  the  most  attractive  place  to  live.  An  ideal 
porch  faces  south  in  winter  and  north  in  summer; 
it  should  have  a  solid  roof,  and  afford  plenty  of 
room  for  its  furnishings ;  if  occupied  by  more  than 
one  person  it  should  permit  of  a  space  of  four  feet 
between  each  individual ;  it  should  never  be  deeper 
than  its  height ;  it  should  be  fitted  with  glass  storm 
screens,  which  should  never  be  closed  on  more  than 
two  sides  at  one  time;  it  need  not  be  supplied  with 
heat  in  any  way,  no  matter  what  the  weather,  and 
should  offer  all  the  advantages  of  the  out-of-doors 
and  afford  at  the  same  time  protection  against 


133  THE  BATTLE  WITH  TUBERCULOSIS 

storm  or  wind ;  it  should  be  lit  with  electricity,  and 
be  screened  from  insects  in  the  hot  weather. 

The  bed  should  be  of  iron  and  run  easily  on 
large-sized  rollers.  In  the  case  of  bed  patients,  there 
is  great  advantage  to  the  nurse  in  having  a  high 
hospital  bed.  Good  hair  mattresses  are  best,  and 
in  the  very  cold  weather  two  mattresses  with  a 
thick  layer  of  paper  between  them  add  much  to  the 
warmth.  The  bed  should  not  be  shoved  back  into 
a  corner,  nor  should  it  be  placed  in  a  strong  draught. 
The  current  of  air  may  always  be  modified  by 
placing  a  frame  covered  with  gauze  inside  of  the 
window  frame.  A  movable  back-rest  is  much  ap- 
preciated by  many  bed  patients.  Beside  the  bed 
should  be  placed  a  table  or  stand  with  drawers.  On 
this,  or  in  it,  should  be  kept  all  the  immediate  neces- 
sities of  the  patient,  such  as  the  sputum  cup,  bell, 
reading  lamp,  books,  urinal,  etc.  If  an  electric  bell 
can  be  fitted  up  to  ring  indoors  from  the  bedside, 
it  will  give  a  great  sense  of  security  to  the  patient 
on  winter  nights  when  the  doors  are  closed. 

The  furniture  in  the  patient's  apartments  should 
be  solid,  or,  if  cushioned,  should  be  covered  with 
washable  covers.  It  should  be  well  raised  from  the 
floor,  so  as  to  permit  free  access  to  a  damp  or  oiled 
mop.  If  window  curtains  are  used  in  the  room, 
they  should  not  reach  to  more  than  a  half  a  foot 
from  the  ground,  and  should  be  so  hung  that  they 
may  readily  be  removed  for  washing.  It  is  wise 
to  have  no  curtains,  but  the  room  must  be  furnished 
in  such  a  way  that  it  will  not  pall  on  a  patient's 
sensibilities. 

An  article  of  great  importance  to  a  patient's 


COMMANDEERING  THE  HOME  133 

comfort,  and  one  which  contributes  much  to  a 
faithful  following  of  the  treatment,  is  a  "  chasing 
chair  "  or  invalid  recliner.  Many  a  patient  who 
will  not  stay  on  a  bed  is  quite  content  to  spend 
most  of  his  time  on  a  recliner,  provided  it  is  com- 
fortable. There  is  an  extensive  variety  of  chasing 
chairs,  and  the  important  considerations  in  choos- 
ing one  are  that  it  should  have  a  broad,  flat  back, 
which  will  in  no  way  bow  or  restrict  the  shoulders 
or  allow  the  spine  to  bulge  backwards  in  a  curve ; 
that  it  should  be  sufficiently  substantial  to  impart  a 
feeling  of  perfect  safety  and  thus  permit  relaxa- 
tion; that  it  should  not  be  too  heavy,  and  should 
be  movable  on  easily  running  castors.  A  metal 
chair  perhaps  lasts  longer  than  any  other,  but  it  is 
too  heavy.  The  chair  selected  should  be  one  which 
may  with  ease  be  moved  into  the  shade,  out  into 
the  garden,  or  up  on  the  veranda.^  Swing  chairs  are 
not  desirable,  and  a  hammock  is  forbidden  on 
account  of  the  cramped  position  it  enforces.  A 
wheeled  chair,  while  too  much  of  a  luxury  for  the 
great  majority  of  patients,  is  of  considerable  help 
to  convalescents  from  acute  exacerbations  or 
complications. 

During  winter  time,  in  cold  climates,  the  patient 
who  is  not  properly  equipped  with  clothing  is  un- 
likely to  make  a  success  of  fresh-air  treatment.  The 
ideal  covering  is  a  fur  coat  and  fur  rugs,  but  many 
patients  do  well  with  steamer  rugs,  horse  or  ordi- 

*  A  free  catalogue  of  the  W.  C.  Leonard  Company,  Saranac 
Lake,  New  York  State,  illustrates  in  very  excellent  cuts  not 
only  reclining  chairs,  but  many  articles  of  equipment  espe- 
cially manufactured  for  use  by  the  tuberculous  patient. 


X34  THE  BATTLE  WITH  TUBERCULOSIS 

nary  blankets  or  quilts.  A  sweater  under  the  coat 
is  good,  a  cardigan  jacket  is  better.  Chamois 
jackets  or  other  clothing  which  prevents  skin  venti- 
lation should  not  be  worn.  A  sash  about  the  waist 
outside  of  the  overcoat  adds  much  to  the  warmth. 

The  hands  and  feet  require  the  best  of  coverings. 
Fur  or  pure  wool  mittens,  extending  over  and  em- 
bracing the  cuff  of  the  coat,  are  excellent  for  the 
hands,  and  for  the  feet  there  are  specially  con- 
structed foot-muffs,  loose  fitting  felt  shoes,  fur- 
lined  moccasins,  wool  stockings,  with  or  without 
lisle  thread  stockings  under  them.  Equestrienne 
tights  are  advisable  for  women.  A  covering  for 
the  head  as  light  as  desired,  such  as  a  toque,  may 
be  used.  The  seasoned  patient  may  go  without  any 
covering  for  the  head  except  when  in  the  sun.  At 
night,  in  cold  weather,  the  patient  should  wear  a 
closely-fitting  suit  of  underclothes  with  woollen 
or  flannelette  night  garments.  In  addition  to 
these,  on  the  coldest  nights,  a  sweater  or  bath- 
robe, a  woollen  hood  covering  the  ears,  and  bed- 
socks  are  necessary. 

The  bed  should  be  equipped  with  from  three 
to  five  pairs  of  double  blankets  and  with  a  sheet 
of  mackintosh  to  cover  these.  There  should  be 
flannelette  sheets  as  well  and  a  few  squares  of 
flannelette  to  place  on  the  pillow  where  the  breath 
freezes;  these  may  be  removed  one  by  one  as 
they  become  uncomfortable.  Three  pillows,  one 
across  the  top  of  the  bed,  and  one  down  each 
side  so  as  to  make  walls  for  the  shoulders,  com- 
plete what  is  desirable  in  cold  weather. 

The  foregoing  approaches  the  ideal  home  equip- 


COMMANDEERING  THE  HOME  135 

oment,  but  while  patients  should  endeavor  to  ap- 
proach the  ideal  in  so  far  as  is  possible,  there  are 
many  who  have  to  be  content  to  do  their  best  under 
conditions  less  luxurious.  Truly,  in  fighting  the 
tuberculosis  battle,  "  Necessity  is  the  mother  of  in- 
vention," and  it  would  be  a  tonic  to  many  a  man 
who  thinks  his  lot  is  hard  to  see  the  obstacles  over- 
come, and  the  principles  of  rest  and  fresh  air  car- 
ried out,  by  the  very  poor  patients  in  the  heart  of 
every  great  metropolis.  There  one  sees  the  window 
tent  and  the  roof  tent  which  take  the  place  of  the 
sleeping-porch;  also  the  roof  bungalow  and  the 
piano-box  nailed  to  the  wall  just  outside  the  win- 
dow. The  charm  of  them  all  is  that  they  bring  good 
results.  Earnestness,  not  money ;  perseverance,  not 
luxury;  and  grit,  not  ease,  win  the  day:  "  To  him 
that  overcometh  will  I  give  to  eat  of  the  Tree  of 
Life." 


CHAPTER  XVI 
The  Commissariat 

We  have  seen  that  where  the  best  equipment 
for  the  invahd's  rest  hours  cannot  be  procured,  the 
second  best  will  very  often  bring  results  just  as 
satisfactory.  Unfortunately,  in  the  next  item  of 
equipment,  namely,  food,  substitution  of  a  poorer 
for  a  better  grade  does  not  afford  the  same  results. 
The  old-time  name,  consumption,  tells  the  story  of 
wasting  and  diminished  nutrition,  and  if  the  tuber- 
culous patient  is  to  got  well,  not  only  must  he  eat, 
but  he  must  eat  good  food. 

In  the  case  of  many  invalids,  the  instinct  for 
food  becomes  perverted  and  manifests  itself  in  a 
craving  for  a  variety  of  food  which  fails  to  satisfy 
the  urgent  physical  need.  Generally  speaking,  the 
patient  should  be  giverra  generous  variety  of  food, 
and  attention  should  be  paid  to  his  special  cravings, 
but  his  chief  articles  of  diet  should  fulfil  two 
demands — they  should  be  highly  nutritious,  and 
they  should  not  impose  too  much  work  on  the 
organs  of  digestion.  The  foremost  food  in  this 
class  is  milk. 

A  patient  on  a  general  diet  should  drink  from 
three  to  four  pints  of  milk  daily,  and  many  patients 
are  able  to  consume  daily  as  much  as  a  gallon  or 
even  one  gallon  and  a  half.  It  is  important  that  the 
milk  should  be  fresh.  If  possible,  it  should  be  con- 
sumed wiihin  twelve  hours,  or,  at  most,  twenty- 

136 


THE  COMMISSARIAT  137 

four  hours  after  the  milking,  because  changes  occur 
in  old  milk  which  render  it  more  difficult  of  di- 
gestion. If  milk  can  be  drunk  when  warm,  just 
as  it  comes  from  the  cow,  it  is  most  easily  di- 
gested. It  need  hardly  be  pointed  out  that  the 
milk  should  come  from  healthy,  well-fed  cattle, 
and  that  it  should  be  kept  scrupulously  clean  and 
well-chilled.  Many  patients  who  think  they  can- 
not take  milk  soon  become  fond  of  it  by  exercis- 
ing a  httle  patience  and  perseverance.  Sometimes 
by  adding  a  little  table  salt,  one  or  two  tablespoon- 
fuls  of  lime-water,  or  some  aerated  water,  milk 
may  be  more  readily  tolerated.  Flavoring  it  with 
a  little  coffee  or  tea  is  often  helpful ;  or  it  may  be 
taken  liberally  in  milk  soups  or  with  porridge, 
junket,  puddings  and  the  like.  Whey  and  butter- 
milk are  not  as  valuable  a  food  as  milk.  When  milk 
cannot  be  taken,  there  should  be  an  increase  in  the 
amount  of  cream  and  butter  consumed. 

Eggs  come  next  in  importance.  From  two  to 
thirty  a  day  may  be  taken.  Six  a  day  is  probably 
a  safe  limit.  They  are  more  easily  digested  when 
raw  than  when  cooked,  and  when  raw  are  readily 
swallowed  with  a  sprinkling  of  salt  or  a  squeeze 
of  lemon  juice.  Whenever  an  extra  egg  may  be 
incorporated  in  a  pudding  or  sauce,  it  is  well  that 
it  should  be  put  in. 

The  third  article  of  importance  on  the  list  is 
meat.  Good  red  meat  is  best  and  should  be  pre- 
pared by  broiling  or  roasting  in  such  a  way  that 
the  juices  are  retained.  Fried  meats  are  difficult 
of  digestion  and  should  be  eliminated.  In  value  to 
the  tuberculous  patient,  meats  stand  thus:   Beef, 


138  THE  BATTLE  WITH  TUBERCULOSIS 

mutton,  poultry,  game.  Veal  and  pork  may  be 
eaten  occasionally,  but  they  take  long  to  digest  and 
are  better  avoided  by  those  whose  digestions  are 
not  of  the  best.  Expressed  beef-juice  ^  is  the 
quintessence  of  food,  and  its  value  to  the  tuber- 
culous patient  is  only  equalled  by  its  cost.  A  wine- 
glassful  between  meals,  twice  daily,  represents 
from  one  to  two  pounds  of  round  steak.  The  so- 
called  beef-tea  and  broths  contain  but  little  more 
nourishment  than  hot  water.  Their  chief  value  lies 
in  the  stimulation  they  afford. 

The  more  fat  a  tuberculous  patient  can  assimi- 
late, the  better  the  outlook  for  his  recovery.  Gen- 
erally speaking,  the  lower  the  temperature  at  which 
a  fat  remains  fluid,  the  more  easily  is  it  absorbed. 
Thus,  oils  and  cream  come  first,  then  butter,  and, 
finally,  meat  fats.  Cod  liver  oil  has  for  many  years 
been  an  outstanding  food  for  the  tuberculous,  and, 
provided  it  does  not  upset  the  stomach  or  interfere 
with  the  appetite,  there  is  none  better.  The  pure 
oil  is  best,  but  it  is  wise  to  make  a  start  with  an 
emulsion  in  half  teaspoon ful  doses,  one  to  two 
hours  after  meals,  and  gradually  increase  it  to 
one  or  two  tablespoon fuls  a  dose.  If  this  be  well 
borne,  the  pure  oil  may  then  be  tried.  It  is  well 
to  defer  making  a  start  in  the  use  of  either  the 
emulsion  or  pure  oil  until  the  cold  weather.  One 
or  two  tablespoon  fuls  of  cream  after  each  meal 
is  an  excellent  substitute.  It  should  become  a 
habit  to  include  plenty  of  cream  and  butter  in  every 
variety  of  food  that  will  permit  of  it.    Large  quan- 

*  See  Appendix  for  preparation  of  expressed  beef-juice. 


THE  COMMISSARIAT  I39 

titles  of  cream  on  fruit  and  an  abundance  of  butter 
on  bread  and  in  vegetables  are  most  helpful. 
Browned  beef  fat,  the  fat  of  lamb  or  mutton  chops, 
bacon,  oily  fish  like  sardines  and  salmon,  olive 
oil  pure,  or  on  salads,  or  in  salad  dressings,  cheese 
and  ice  cream  are  all  good.  Second  dishes,  or 
meats  cooked  over  the  second  time,  should  be 
avoided. 

When  choosing  vegetables  preference  should  be 
given  to  the  green  ones,  such  as  stringed  beans, 
peas,  asparagus,  spinach,  lettuce  and  the  others. 
Some  vegetables,  such  as  beans  or  peas,  contain 
considerable  proteid  or  the  substance  which  makes 
meat  valuable,  while  others,  such  as  potatoes,  are 
nearly  entirely  carbohydrate  or  starchy.  Green 
vegetables  like  spinach  contain  considerable  iron, 
which  is  of  much  value  to  the  blood.  While  bread 
and  potatoes  may  be  freely  consumed,  they  should 
not  be  eaten  to  the  exclusion  of  meats  and  fats, 
which  are  more  necessary  in  tuberculosis.  Vege- 
tables such  as  cabbage,  turnips,  and  the  like  may 
be  eaten  freely,  but  they  have  a  comparatively  small 
food  value  for  their  bulk,  and  would  be  a  poor 
substitute  as  a  chief  article  of  diet.  Vegetable 
purees  of  all  kinds  are  much  more  valuable  than 
beef -tea,  and  should  be  substituted  for  or  combined 
with  the  clear  soups. 

Among  breadstufifs  (carbohydrates)  cereals  are 
probably  of  the  greatest  value.  Bread,  of  course, 
must  always  form  an  important  article  of  diet. 
By  way  of  a  treat,  a  few  candies  may  be  permitted 
once  in  a  long  while,  but  they  should  be  eaten 
immediately  after  a  meal  and  never  between  or 


I40  THE  BATTLE  WITH  TUBERCULOSIS 

ibefore  meals.  For  a  patient  to  eat  candies  when- 
ever he  feels  like  it  is  to  impose  a  serious  obstacle 
in  the  way  of  recovery.  Nuts,  however,  may  be  sub- 
stituted for  candies,  and,  if  eaten  immediately  after 
meals,  may  be  indulged  in  fairly  freely.  Among 
desserts,  the  variously  flavored  gelatines  are  valu- 
able and  should  find  a  place,  particularly  in  the 
hot  weather. 

Water,  while  not  a  food,  is,  nevertheless,  a  neces- 
sity to  well-being.  It  should  be  drunk  freely  any- 
where from  two  hours  to  one-half  hour  before 
meals,  and  must  be  taken  systematically.  Generally 
the  minimum  amount  should  consist  of  a  glassful  on 
rising  in  the  morning,  one  at  the  beginning  of  each 
rest  hour  before  meals,  and  one  at  bedtime.  Con- 
siderably more  than  this  is  permissible,  but  water 
with  meals  should  be  limited,  as  there  is  always  the 
possibility  of  so  diluting  the  digestive  juices  that 
they  will  be  unable  to  properly  carry  out  their 
functions.  Pure  grape  juice  is  of  value  as  a 
beverage,  but  pop,  ginger  ale,  lemon  sour  and 
such  concoctions  should  be  ruled  out.  Tea,  coffee, 
and  cocoa  in  moderation  are  quite  permissible,  and 
often  afford  valuable  stimulation  to  the  appetite. 
A  cup  of  coffee  for  breakfast  is  also  stimulating 
to  the  bowels,  and  to  many  people  ensures  the 
proper  evacuation  fifteen  to  thirty  minutes  later. 

Alcoholic  beverages  such  as  beer,  wines,  etc., 
are  advisable  only  to  those  who  would  suffer  as 
the  result  of  their  discontinuance,  and  in  such  in- 
stances the  doctor  is  the  one  to  determine  whether 
or  not  they  are  required.  The  man  or  woman  who 
has  never  used  alcohol  in  any  form  has  something 


THE  COMMISSARIAT  141 

to  the  credit  side  of  his  resistance  not  possessed 
by  the  individual  who  has  long  relied  on  artificial 
stimulation.  There  may  arise  emergencies  during 
the  course  of  tuberculosis  when  alcohol  is  indi- 
cated, and  it  is  well  if  the  system  is  unhampered 
by  habit  and  can  respond  quickly  to  the  stimula- 
tion; but  such  emergencies  are  infrequent  and  are 
the  occasion  for  special  advice  from  a  doctor.  The 
patient,  whether  he  has  previously  used  alcohol 
or  not,  should  never  institute  on  his  own  account 
a  course  of  beer,  wine,  or  other  stimulants. 

In  general,  alcohol  does  much  more  harm  than 
good,  and  very  often  figures  largely  as  a  causative 
factor  in  allowing  the  tubercle  enemy  to  invade  and 
overcome  his  victim.  Many  a  good  man  who  could 
easily  win  his  battle  has  gone  to  his  death  as  the 
result  of  inability  to  control  his  desire  for  alco- 
holic stimulants.  Where  he  confines  the  habit  to 
himself,  such  an  individual  is  to  be  pitied,  but 
there  are  no  words  of  condemnation  sufficiently 
strong  for  the  man  who  insists  on  dragging  with 
him  others  more  innocent  or  feeble-minded  than 
himself.  Let  him  who  persists  in  drinking,  drink 
if  he  must,  and  the  more  he  drinks,  the  sooner  it 
will  all  be  over,  but  at  least  let  him  have  the 
decency  to  stay  away  from  places  where  other  men 
are  doing  their  best  to  get  well. 

The  housekeeper  for  tuberculous  patients  should 
realize  that  "  a  patient  who  eats  and  digests  well 
is  a  patient  half  cured."  The  first  great  essential 
to  a  good  appetite  and  good  assimilation  is  regu- 
larity. The  meals  should  be  on  the  table  at  the 
regular  hour  each  day,  and  that  hour  may  very 


142  THE  BATTLE  WITH  TUBERCULOSIS 

well  be  patterned  on  what  has  been  the  previous 
habit  of  the  patient,  provided  it  leaves  an  interval 
of  five  hours  between  meals.  The  table  should  be 
made  to  look  attractive  and  inviting,  and  the  food 
should  be  served  quickly  without  long  intervals 
between  courses.  It  is  inuch  wiser  to  encourage 
the  patient  to  come  back  for  a  second  helping  than 
to  heap  up  his  plate  with  food.  Ag  extensive  a 
variety  of  food  as  is  compatible  with  the  right 
things  to  eat  is  wise,  and  the  catering  of  certain 
dishes  on  regular  days  should  be  religiously 
avoided.  When  the  patient  is  in  bed,  the  tray 
should  be  daintily  arranged,  and  care  should  be 
taken  to  avoid  the  slopping  over  of  soup,  milk,  or 
other  liquids.  Slopped-over  food  plus  a  few  flies  is 
enough  to  spoil  the  api>etite  of  even  a  healthy  man. 
The  patient  should  make  it  an  invariable  rule 
never  to  partake  of  a  meal  when  tired.  Rather 
than  do  so,  it  is  better  to  lie  down  and  let  the 
meal  wait  half  an  hour.  But  the  man  who  is 
regular  with  rest  hours  will  not  have  to  resort  to 
such  an  expedient.  One  should  eat  and  drink 
slowly,  and  chew  the  food  well,  and  while  it  is 
wise  to  eat  plenty,  it  should  be  remembered  that 
too  much  is  worse  than  not  enough,  A  happy 
conversation  at  meals  is  an  aid  to  digestion  and  a 
stimulus  to  the  appetite,  but  irritability  or  a  heated 
discussion  is  an  inhibitor  both  to  appetite  and 
digestion.  It  is  often  an  advantage  for  the  bed 
patient  to  have  a  nurse  to  encourage,  coax,  or  even 
command  him  to  eat,  although  to  have  to  carry 
on  a  conversation  with  a  stranger  while  eating  is 
worse  for  the  bed  patient  than  being  alone. 


THE  COMMISSARIAT  143 

There  is  no  better  tonic  to  the  appetite  of  the 
tuberculous  patient  than  rest  in  the  fresh  air.  Many 
a  patient  whose  appetite  has  completely  gone, 
through  exercising  too  freely,  will  eat  a  surpris- 
ingly large  meal  after  a  few  weeks  of  rest  in  the 
fresh  air.  In  fact,  without  the  rest,  digestion  is 
often  impossible,  and  fresh  air  is  a  great  stimula- 
tion to  the  powers  of  assimilation.  Rest  after 
eating  is  equally  important.  The  tuberculous 
patient  should  never  go  so  long  without  food  that 
he  is  very  hungry.  This  is  why  a  lunch  between 
meals  is  often  valuable.  At  the  same  time  a  desire 
to  eat  when  sitting  down  to  a  meal  is  most  im- 
portant, and  if  a  luncheon  robs  one  of  this  desire, 
it  is  just  as  well  to  omit  it  unless  for  special  reasons 
the  doctor  thinks  it  is  advisable. 

Hunger  during  the  night  should  be  satisfied  with 
a  glass  of  warm  milk  or  something  even  more  sub- 
stantial. Very  often  sleeplessness  is  overcome  by 
taking  a  warm  drink  or  something  to  eat.  In  the 
case  of  many  bed  patients,  the  appetite  is  improved 
by  sitting  up  to  a  table  for  meals  instead  of  having 
a  tray  in  bed.  Thus,  when  any  exercise  at  all  is 
permissible  it  should  be  taken  at  mealtime,  even  if 
the  patient  is  only  allowed  to  sit  up  to  a  little  table 
beside  the  bed.  When  a  patient's  weight  rises  above 
normal,  it  is  just  as  well  to  discontinue  all  extra 
feeding  such  as  luncheons,  and  where  a  patient 
appears  to  ingest  an  abnormal  amount  of  food,  he 
will  be  safer  to  have  the  excess  food  consist  of  fats 
rather  than  meats. 

No  patient  can  eat  abundantly  or  digest  prop- 
erly if  he  does  not  attend  carefully  to  the  elimina- 


144  THE  BATTLE  WITH  TUBERCULOSIS 

tion  of  waste  products  from  the  bowels.  Regu- 
larity in  this  regard  is  just  as  important  as  eating 
or  sleeping.  In  fact,  the  daily  evacuation  of  the 
bowels  depends  on  regularity  for  its  successful 
action.  Once  allow  the  regular  time  for  evacuation 
to  be  broken  into  for  any  reason  and  there  is  always 
trouble  for  a  few  days  until  the  habit  becomes 
reestablished.  The  secret  for  overcoming  consti- 
pation is  regularity.  A  regular  hour,  preferably 
a  few  minutes  after  breakfast,  should  be  fixed, 
and  no  matter  what  happens,  one  should  never 
fail  to  secure  a  movement  at  that  hour.  If  the 
action  does  not  come  naturally  after  ten  minutes' 
earnest  attempt,  a  glycerine  suppository  may  be 
used.  This  will  probably  be  effective  inside  of  five 
minutes.  If  not,  a  soap-and- water  enema  should 
follow,  and  this  will  be  effective.  It  is  not  advis- 
able that  the  enema  should  be  repeated  indefinitely, 
but  generally  one  week  or  a  fortnight  of  determined 
effort  in  securing  a  movement  at  the  one  regular 
hour  establishes  a  habit  which  will  persist  without 
artificial  aid.  If  such  does  not  prove  to  be  the 
case,  the  doctor  should  be  consulted,  because  consti- 
pation is  too  pernicious  in  its  effects,  and  too  readily 
corrected,  to  be  allowed  to  continue. 


CHAPTER  XVII 
The  Beginning  of  the  Battle 

.When  first  the  tubercle  enemy  gains  the  balance 
of  power  in  the  body,  and  begins  to  make  sorties 
into  the  lung  tissue  or  other  areas,  the  white  cells 
and  their  allies  in  the  blood  are  but  raw  recruits, 
and  have  neither  the  ingenuity  nor  agility  in  meeting 
emergencies  or  adverse  conditions  that  later  on 
they  acquire  through  experience  in  the  disease.  It 
is  for  this  reason  that  your  generalship  in  the  be- 
ginning of  the  battle  should  be  based  on  a  policy 
of  extreme  caution,  a  line  of  action  that  takes  no 
chances.  It  is  quite  possible  that  after  your  white 
cells  have  become  experienced  veterans  you  may 
impose  upon  them  many  new  responsibilities,  but 
while  they  are  recruits  you  must  show  them  great 
consideration  and  watch  carefully  every  movement 
of  the  enemy. 

Two  cardinal  principles  should  be  applied  to 
any  fighting  force:  the  army  should  be  well  fed, 
and  there  should  be  a  limitation  of  the  amount  of 
work  it  is  expected  to  perform  in  a  given  time. 
In  other  words,  adequate  food  and  rest  are  neces- 
sary to  the  performance  of  good  work.  The  white 
cells  and  their  allies  do  not  take  their  rest  by 
stopping  work  and  going  to  sleep;  their  rest  is 
only  relative  and  means  simply  that  they  do  not 
work  as  hard  as  usual.  As  will  be  explained  in 
the  next  chapter,  the  white  cells  have  many  more 
10  145 


146         THE  BATTLE  WITH  TUBERCULOSIS 

difficulties  to  overcome  when  you  are  exercising 
than  when  your  body  is  at  rest.  Generally  speak- 
ing, while  you  sleep,  there  are  fewer  handicaps  en- 
countered, and  at  that  time  the  white  cells  are 
most  effective  in  their  battle  against  the  tubercle 
enemy.  Keep  constantly  in  your  mind  the  picture 
of  the  conflict  as  described  in  Chapter  IV,  and, 
particularly  during  the  beginning  of  the  battle,  sup- 
port your  inexperienced  recruits  all  you  possibly 
can  by  keeping  your  body  at  rest. 

The  word  "  rest "  has  a  vastly  different  meaning 
to  different  people.  To  one  it  may  recall  a  sojourn 
in  bed  with  only  one  pillow  under  his  head  and  all 
meals  administered  through  a  tube.  To  another 
it  may  mean  a  trip  to  the  country  with  hunting, 
mountain  climbing,  and  perhaps  a  little  broncho 
busting  by  way  of  diversion.  To  you,  during  silent 
rest  hours,  it  should  mean  a  condition  approaching 
as  nearly  as  possible  to  sleep.  It  is  not  sufficient  that 
you  should  merely  lie  on  the  bed,  or  even  in  it. 
Many  patients  accomplish  this  as  a  fish  might,  by 
touching  the  bed  only  at  the  extremities,  the  body 
remaining  rigid.  You  must  endeavor  to  lie  through 
the  bed,  to  make  yourself  as  heavy  as  possible,  to 
give  way  in  every  muscle,  so  that  if  the  bed  were 
suddenly  to  break,  your  collapse  would  be  complete. 
This  may  be  accomplished  in  different  positions, 
but  it  is  most  easily  'attained  by  lying  supine  on  the 
back  with  but  one  pillow  under  the  head,  with  the 
arms  thrown  wide  and  the  palms  up,  with  the  feet 
about  half  a  yard  apart,  with  the  jaw  relaxed  but 
the  mouth  closed,  and  the  body  in  very  much  the 


THE  BEGINNING  OF  THE  BATTLE  147 

attitude  in  which  you  would  expect  to  find  a  dead 
soldier  lying  on  the  battlefield.^ 

Your  mind  should  be  as  your  body — not  riveted 
to  -any  one  point,  but  so  dreamily  relaxed  that 
if  any  one  were  to  ask  you,  "  What  are  you  think- 
ing about  ? "  you  would  be  unable  to  tell  him. 
This  cannot  all  be  accomplished  at  once.  Practice 
and  perseverance  will  be  required,  but  even  if,  for 
months,  it  seems  impossible  to  properly  relax  in 
rest,  there  is  no  excuse  for  your  becoming  actively 
restless  as  you  are  when  reading,  talking,  or  carry- 
ing on  some  work  or  play  with  your  hands.  The 
nearer  you  come  to  complete  relaxation  at  any  one 
time,  the  more  readily  will  you  accomplish  it  on 
subsequent  occasions,  and  you  are  well  repaid  for 
the  effort,  because  such  rest  Is  one  of  the  greatest 
possible  aids  to  your  white  cells  in  their  struggle. 

Although  there  are  many  methods  by  which  the 
doctor  may  determine  the  activity  of  the  enemy, 
you  must  rely  on  your  temperature,  pulse,  and  gen- 
eral feelings  to  indicate  how  the  battle  is  going. 
You  should  have  your  own  thermometer,  and  keep 
it  in  'a  wide-necked  bottle  containing  a  solution  of 
5  per  cent,  carbolic  acid,  and  a  padding  of  ab- 
sorbent cotton  in  the  bottom.  Temperature  and 
pulse  should  be  taken  just  'after  waking  in  the 
morning,  before  you  begin  to  stir  around ;  at  twelve 
no^n;  at  four,  and  at  eight  p.m.  Have  somebody 
instruct  you  In  the  reading  of  the  thermometer 
and  the  counting  of  your  pulse-beats  per  minute, 
and  in  a  week  or  two  you  will  become  quite  expert. 

*For  a  further  consideration  of  this  subject  read  "Power 
through  Repose,"  by  Anna  Payson  Call. 


148  THE  BATTLE  WITH  TUBERCULOSIS 

Do  not  mind  the  remarks  of  friends  to  the  effect 
that  you  should  "  forget  it."  So  long  as  the  doctor 
sees  no  objection  to  your  doing  this  for  yourself,  it 
cannot  but  do  good  that  you  should  be  aware  of 
the  activity  of  the  enemy. 

A  further  control  and  systematizing  of  your 
activities  is  to  be  gained  through  the  careful  keep- 
ing of  a  chart.  If  your  doctor  does  not  supply 
them  you  may  readily  rule  one  for  yourself  each 
week.  By  filling  it  out  carefully,  there  will  be  no 
time  during  the  day  for  which  account  is  not  given, 
and  this  is  an  important  part  of  the  business  of 
getting  well.  Institute  a  regular  time  and  fill  out 
your  chart  at  that  time  every  day.  In  addition 
to  aiding  you  to  a  control  of  yourself,  it  will  give 
to  the  doctor  very  necessary  information  for  the 
regulation  of  your  treatment. 

As  a  guide  to  the  course  of  the  struggle,  your 
feelings  are  apt  to  be  deceptive,  and,  in  the  begin- 
ning of  the  battle,  the  negative  feelings  are  more 
significant  than  the  positive  ones.  Feelings  of 
tiredness,  or  not  feeling  well,  are  the  equivalent 
of  fever,  and  should  impose  identically  the  same 
restrictions  as  does  an  elevated  temperature. 
Many  scientists  hold  that  the  pulse  is  a  better  cri- 
terion of  the  violence  of  the  fighting  within  the 
chest  than  is  the  temperature,  so  that,  in  the  absence 
of  fever,  a  pulse  continually  faster  than  the  normal 
should  call  forth  the  same  caution  that  elevated 
temperature  does.  The  pulse  varies  considerably 
in  frequency  in  different  individuals,  and  your 
normal  pulse-rate  should  be  ascertained  from  your 
doctor. 


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THE  BEGINNING  OF  THE  BATTLE  149 

There  are  few  wars  in  which  neutrals  and  non- 
combatants  do  not  suffer  to  a  greater  or  less  extent, 
and  the  war  against  the  tubercle  bacillus  is  no  ex- 
ception in  this  respect.  The  tuberculosis  battle  will 
scarcely  have  started  before  the  question  arises — 
Is  there  much  danger  for  the  non-combatant  mem- 
bers of  the  family?  One  thing  is  certain,  if  the 
enemy  can  make  his  escape,  he  will  exercise  no 
discrimination  in  the  persons  he  attacks,  be  they 
neutral,  combatant  or  non-combatant.  Safety  lies 
only  in  the  proper  care  of  the  sputum.^ 

More  than  seven  billion  tubercle  bacilli  may  be 
expectorated  in  twenty- four  hours  by  one  patient. 
If  the  sputum  is  as  carefully  controlled  as  is  the  fire 
in  the  furnace,  the  fear  of  attack  should  be  no 
greater  than  the  fear  of  the  house  taking  fire  from 
the  furnace.  Accidents  are  just  as  liable  to  occur 
with  the  one  as  the  other.  As  a  rule  the  intelligent 
and  careful  patient,  with  a  moderate  amount  of 
trouble,  is  of  very  little  danger  to  the  adults  with 
whom  he  lives.  Not  so,  however,  the  far-advanced 
consumptive  who  is  not  strong  enough  to  look  after 
his  needs.  In  such  a  case,  not  only  the  sputum,  but 
the  other  body  excretions  as  well,  are  fraught  with 
danger  if  not  properly  handled.  Consequently  a 
strong,  competent  nurse  must  take  over  the  respon- 
sibility which  the  poor  fellow  is  incapable  of  holding 
for  himself. 

A  beard  or  moustache  adds  considerably  to 
danger.  It  must  also  be  remembered  that  there  is 
always  the  possibility  of  unfortunate  results  to 

*  See  Appendix,  Disposal  of  Sputum. 


150    THE  BATTLE  WITH  TUBERCULOSIS 

the  child  who  associates  with  the  tuberculous 
patient,  be  he  an  early  or  advanced  case,  just  as 
there  is  danger  for  the  child  who  plays  with  the 
furnace.  The  little  ones  are  very  easily  infected, 
and  their  ignorance  and  beautiful  affection  ren- 
der them  quite  indifferent  to  the  danger  of  being 
handled  and  fondled  to  say  nothing  of  being  kissed 
The  road  of  the  tuberculous  is  the  road  of  renun- 
ciation, and  we  fathers  and  mothers  who  have 
the  disease  must  withhold  our  demonstrations  of 
love  and  affection  until  a  happier  and  more  health- 
ful season. 

The  tuberculous  mother,  if  she  would  value  the 
life  of  her  new-born  infant,  must  give  its  nursing 
and  care  over  entirely  to  hands  of  strength,  if  not 
of  sympathy.  The  relative,  should  he  be  one  in 
whom  the  enemy  has  also  gained  a  hold,  would  con- 
fer on  little  children  a  true  kindness  would  he  not 
only  bar  them  from  his  bedchamber,  but  confine 
his  associations  with  them  to  the  out-of-doors. 

Apparently  there  are  many  adults,  as  well  as 
children,  who  have  to  learn  that  the  tuberculous 
patient,  like  the  furnace,  may  be  enjoyed,  but  that 
there  are  limits  to  the  intimacy  of  the  enjoyment 
It  is,  for  example,  quite  unnecessary  to  be  con- 
stantly within  the  four- foot  limit.  There  is  no 
need  to  make  the  patient  feel  that  an  imaginary 
barrier  holds  him  at  a  distance,  but  for  closet 
proximity,  such  as  exists  in  sharing  the  same  bed, 
there  is  no  excuse.  The  fine  spray  that  is  emitted 
when  the  patient  coughs  or  breathes  is  probably 
quite  harmless,  but  not  so  the  fine  globules  of 
sputum  that  at  such  a  time,  on  some  occasions,  gain 


THE  BEGINNING  OF  THE  BATTLE  151 

liberty.  As  a  consequence,  the  patient  should  make 
it  a  rule,  in  so  far  as  possible,  to  cough  into  his  spu- 
tum cup  and  not  into  his  hand  or  handkerchief. 

The  square  tin  cup  with  spring  lid  and  cardboard 
fillers  is  the  best  for  ordinary  use.  The  practice 
of  expectorating  Into  pieces  of  paper,  or  of  cotton, 
and  of  putting  these  Into  the  pocket,  even  although 
the  latter  is  rubber  lined,  is  a  dangerous  practice. 
For  street  use  one  should  have  a  pocket  cup  which 
must  never  be  filled  beyond  the  point  of  safety. 
A  cardboard  pocket  cup,  which  may  be  burned  after 
using  a  limited  number  of  times,  is  best. 

When  coughing  in  the  presence  of  others,  It  is 
safe  to  place  a  clean  handkerchief  in  front  of  the 
mouth,  but  one  must  be  careful  to  apply  to  the 
mouth  a  part  of  the  handkerchief,  which  may  after- 
wards be  folded  within  the  unused  parts.  A  hand- 
kerchief should  never  be  shaken  out  with  a  flourish ; 
it  is  most  important  also  that  it  should  be  boiled  and 
laundered  after  being  used  a  very  few  times.  One 
should  never  expectorate  into  a  handkerchief. 
Such  a  procedure  is  most  dangerous  and  deserves 
the  severest  censure.  It  should  be  a  rule  that  the 
pocket  which  holds  the  handkerchief  or  sputum 
cup  should  be  turned  inside  out  and  exposed  to 
the  sunlight  at  least  once  a  week.^  When  a  patient 
is  bedridden,  and  is  too  weak  to  properly  manage 
a  sputum  cup,  squares  of  gauze,  old  cotton  or  toilet 
paper,  are  just  the  thing  for  him  to  expectorate 
into;  after  being  used  once  they  should  be  dropped 
into  a  paper  bag  pinned  to  the  side  of  the  bed. 

■  See  Appendix,  Disinfection  of  Clothes. 


152  THE  BATTLE  WITH  TUBERCULOSIS 

Every  twelve  or  twenty-four  hours  the  bag  with  its 
contents  should  be  dropped  into  the  fire. 

The  patient,  and,  indeed,  every  one  in  the  same 
house,  must  be  careful  to  frequently  disinfect  his 
hands  with  a  good  brand  of  carbolic  soap.  The 
man  who  would  shake  hands,  just  after  spraying 
his  own  hand  with  sputum  which  may  have  been 
expelled  while  coughing,  is  surely  unworthy  of 
association  with  his  fellowmen.  Remember  also 
the  possibility  of  contaminating  door-knobs,  chil- 
dren's toys,  or  the  hands  of  the  little  people  when 
unsuspectingly  they  walk  with  you  hand  in  hand. 
While  there  is  no  need  of  giving  to  the  sick  man 
an  individual  set  of  dishes,  it  should  be  seen  that 
his  dishes,  and  especially  such  utensils  as  come  into 
direct  contact  with  his  mouth,  are  properly  dis- 
infected by  boiling  before  washing.'*  As  drinking 
glasses  are  readily  cracked  on  boiling,  it  is  an  easy 
matter  to  supply  the  patient  with  timiblers  of  an 
odd  pattern  which  may  be  readily  distinguished 
from  those  used  by  the  family.  The  patient  should, 
of  course,  have  his  own  towel,  and  it  is  just  as 
wise  for  him  to  keep  his  tooth-brush  in  a  case. 
Laundry  should  be  handled  as  little  as  possible, 
and  where  it  is  not  going  to  be  submitted  to  the 
regular  steam-laundry  process,  handkerchiefs,  or 
any  articles  which  may  possibly  be  contaminated 
with  sputum,  should  be  disinfected  by  boiling  be- 
fore washing. 

The  danger  of  infecting  pets  with  tuberculosis 

*See  Appendix,  Disinfection  of  Dishes. 


THE  BEGINNING  OF  THE  BATTLE  153 

is  not  nearly  so  great  as  is  the  danger  of  pets  in- 
fecting patients  with  some  secondary  infection. 
A  patient  must  exercise  care  not  to  reinfect  fiim- 
self  by  swallowing  his  sputum.  Tuberculosis  of 
the  bowels  is  always  a  stubborn  and  often  a  dis- 
tressing condition,  and  is  frequently  brought  about 
by  swallowing  sputum. 

All  through  the  tuberculosis  battle,  but  particu- 
larly at  its  beginning,  the  presence  of  a  nurse 
companion  is  most  desirable.  Possibly  at  no  time 
in  the  life  of  a  mother,  a  wife,  a  sister,  or  a  friend 
is  the  opportunity  for  service  and  devotion  so  great 
as  during  the  long,  weary  hours  of  the  conflict,  and 
in  none  of  life's  crises  is  devotion  of  the  practical 
kind  so  helpful  to  the  patient  and  so  much  appre- 
ciated by  him.  During  tlie  balmy  summer  months 
it  requires  but  little  fortitude  to  be  a  companion  to 
the. patient  in  his  "chasing" ;  but  when  in  the  winter 
the  thermometer  drops  with  twenty  degrees  of 
frost,  devotion  finds  its  test  and  the  spirit  declares 
itself.  If  the  mother  or  the  sister  can  give  up 
everything  in  the  home  and  devote  entire  time  to 
the  patient,  much  that  makes  tuberculosis  such  a 
fatal  disease  will  be  overcome. 

Where  a  patient  is  very  ill  in  bed,  a  trained 
nurse  is  desirable.  She  should  be  possessed  of  great 
tact  and  cheerfulness ;  should  understand  to  the  full 
the  value  of  mental  suggestion,  and  should  be 
able  to  exercise  much  ingenuity  in  making  the 
patient  eat.  When  she  begins  to  flag,  it  is  a  relief 
to  her  as  well  as  to  the  patient  to  make  a  change. 
It  is  the  nurse's  business  to  see  to  it  that  no  un- 
necessary dust  is  allowed  to  rise  in  the  patient's 


154  THE  BATTLE  WITH  TUBERCULOSIS 

rcx)m.  The  rugs  must  be  taken  out-of-doors  for 
cleaning,  and  instead  of  sweeping,  the  floors  should 
be  gone  over  daily  with  an  oil  or  damp  mop. 
"  Dusting  "  should  be  carried  out  with  an  oil  or 
damp  cloth  which  collects,  not  scatters,  the  dust. 
When  not  in  use  the  mop  and  duster  should  be 
soaked  in  a  disinfectant.^  If  the  patient  is  weak, 
he  should  not  be  allowed  to  put  on  his  wraps 
unaided-  when  going  out  to  "  chase "  in  the 
cold  weather. 

A  nurse  should  also  realize  that  tuberculous 
patients  are  chronic  procrastinators.  In  the  first 
place,  they  procrastinate  about  going  to  the  doc- 
tor, then  they  procrastinate  about  starting  treat- 
ment; they  always  want  to  delay  going  out-of- 
doors  on  the  cold  days ;  they  put  off  going  to  bed 
until  the  last  moment;  their  procrastination  makes 
them  irregular  in  many  of  their  habits  if  a  rigid 
regime  is  not  enforced.  Much  valuable  time  is 
lost  by  a  patient  loitering  round  inside  the  house 
after  meals.  The  nurse  should  bring  the  patient's 
wraps,  make  him  put  them  on,  if  necessary  shove 
him  out-of-doors>  ai]^  then  tuck  him  in  cosily  on 
his  chasing  chair  or  bed.  It  need  hardly  be  pointed 
out,  however,  that  the  patient  who  avoids  follow- 
ing the  treatment  when  he  is  not  made  to  carry  it 
out  has  a  poor  chance  of  recovery. 

In  cold  weather,  whenever  possible,  the  bed 
should  be  allowed  to  remain  indoors  until  just 
before  it  is  to  be  used,  and  if  .this  be  impractical, 
it  should  be  thoroughly  warmed  with  hot-water 

'  See  Appendix,  Disinfection  of  Dusters,  Mops,  etc. 


THE  BEGINNING  OF  THE  BATTLE  155 

bottles,  hot  bricks,  or  an  electric  pad,  before  the 
patient  gets  into  it.  The  secret  of  comfort  in 
winter  time  lies  in  prevention  from  chilliness,  not 
in  waiting  till  the  cold  is  felt  before  applying 
warmth.  M-uch  suffering  from  chilblains  will  be 
avoided  if  this  rule  is  adhered  to,  as  it  is  the  appli- 
cation of  warmth  to  the  very  cold  skin  surface 
which  causes  chilblains. 

There  is  nothing  harmful  in  night  air  to  the  tuber- 
culous patient.  Indeed,  in  cities,  the  night  air  is 
the  purest.  While  it  is  well  that  a  patient  who  is 
not  very  ill  should  be  out-of-doors  four-fifths  of 
his  time,  or  even  more,  it  is  wise  to  avoid  senseless 
exposure,  such  as  lying  out  in  severe  storms,  or 
when  the  mercury  drops  to  many  degrees  below 
zero.  As  a  rule,  however,  cold  air  is  more  valu- 
able than  warm,  and  if  the  patient  has  fairly  good 
vitality,  and  is  properly  clothed  and  wrapped  up 
in  bed,  exposure  to  the  biting  frost  does  him  no 
harm.  If  he  sleeps  within  doors,  the  heat  should 
be  turned  off,  and  the  windows  should  be  opened 
wide.  In  high  altitudes,  wraps  should  always  be  at 
hand,  even  on  the  warmest  days,  as  the  evening 
shadows  always  bring  a  cool  wave,  and  the  changes 
throughout  the  day  are  liable  to  be  sudden. 

The  nurse  must  regulate  the  number  of  visitors 
and  the  length  of  their  visits.  Of  course,  much 
depends  upon  the  character  of  the  visitor,  but  one 
ten-minute  visit  a  week  from  a  stranger  is  quite 
sufficient  for  the  bed  patient.  Few  of  us  realize 
what  a  strain  it  is  for  the  average  patient  to  talk 
to  a  stranger.  Much  of  a  patient's  life  Is  spent 
alone,  and,  from  forced  inactivity,  the  mind  be- 


156  THE  BATTLE  WITH  TUBERCULOSIS 

comes  weak  like  the  body.  It  need  hardly  be 
pointed  out  that  no  visitors,  not  even  members  of 
the  family,  should  be  admitted  during  silent  rest 
hour.  Generally  speaking,  there  is  no  better  com- 
pany than  a  companion  nurse  of  the  right  type, 
one  who  seems  to  realize  as  if  by  instinct  when  to 
read  aloud,  when  to  laugh  and  be  merry,  and  when 
to  be  silent.  Many  a  patient  who  has  no  desire  to 
talk  finds  a  wealth  of  comfort  just  in  feeling  the 
presence  of  some  one  who  is  sympathetic;  some  one 
who  realizes  the  seriousness  of  the  battle;  some 
one  who  is  hoping  and  praying  for  victory. 


CHAPTER  XVIIT 
The  Fighting  Machine 

There  are  no  days,  or  even  hours,  during  which 
your  army  of  defence  is  entirely  at  peace.  Prac- 
tically always,  at  some  outpost  of  the  body's  fron- 
tier, a  diminutive  skirmish  is  taking  place  between 
the  white  cells  and  some  one  or  more  of  the  count- 
less divisions  of  enemies  which  gain  access  to  the 
human  body.  The  vast  majority  of  skirmishes  are, 
however,  one-sided,  and  it  is  very  much  the  excep- 
tion for  the  white  cells  to  be  overpowered,  even 
temporarily,  by  the  enemy.  Hence,  we  may  dis- 
tinguish between  days  of  peace  and  days  of  war 
by  attributing  to  the  former  the  great  majority 
of  the  days  of  life  when  "  work,  play,  love  and 
worship "  are  the  only  things  which  occupy  our 
thoughts,  and  when  our  army  of  defence  carries 
out  in  a  normal  or  physiological  manner  the  many 
duties  that  make  up  its  daily  round  and  common 
task.  The  days  of  war  begin  when  for  any  reason 
the  white  cells  have  been  temporarily  or  perma- 
nently vanquished  by  the  enemy  germ,  and  when 
the  latter  has  succeeded  in  entrenching  himself 
SMiywhere  in  the  body. 

You  must  not  imagine,  to  speak  metaphorically, 
that  in  days  of  peace  the  anhy  of  defence  sits 
around  and  plays  cards.  Indeed,  when  you  realize 
the  actual  amount  of  work  its  units  are  called  upon 

157 


158    THE  BATTLE  WITH  TUBERCULOSIS 

to  perform  in  days  of  peace,  you  will  never  cease 
to  wonder  how  final  success  attends  the  fighting  of 
such  a  tremendous  and  long-drawn-out  battle  as 
that  which  occurs  with  the  tubercle  bacillus. 

You  must  learn  to  look  upon  your  body  as  a 
wonderfully  constructed  engine  that  operates  in 
much  the  same  manner  and  requires  just  as  careful 
attention  as  a  steam  locomotive.  As  a  locomotive 
requires  fuel  to  run  it,  and  the  fuel  is  useful  only 
because  it  is  converted  into  heat  or  energy,  so  also 
your  body  requires  fuel,  and  if  you  are  wise  you  will 
supply  it  with  fuel  in  the  form  of  plain  nourishing 
food  at  regular  intervals,  three  times  a  day.  Like- 
wise, food  is  useful  only  because  it  is  converted 
into  heat  or  energy,  and  in  the  normal  human 
engine  about  90  per  cent,  of  the  fuel  or  food  is 
utilized.  Before  food  can  be  made  use  of  in  the 
form  of  heat  or  energy,  it  must  first  of  all  be  dis- 
solved or  digested  in  the  stomach.  Some  foods 
naturally  dissolve  more  readily  and  completely  than 
others. 

Just  as  coal  has  to  be  stoked  into  the  fire-box  of 
an  engine,  so  also  must  food,  after  it  is  dissolved, 
be  stoked  or  absorbed  into  the  human  engine.  The 
cells  which  line  the  stomach  wall,  and  which  in 
many  ways  resemble  stationary  white  cells,  are  the 
stokers,  and  they  have  the  tremendous  task  of  pick- 
ing out  the  good  food  from  the  bad,  or  the  useful 
from  the  useless,  and  of  carrying  it  bit  by  bit, 
load  after  load,  into  the  body.  The  white  cells 
seem  to  assist  in  this  work  by  devoting  themselves 
to  the  little  globules  of  fat  in  the  food,  and  by 
unloading  them  from  the  stomach  wall  cells  and 


THE  FIGHTING  MACHINE  159 

carrying  them  into  the  body.  Supposing  that, 
while  the  white  cells  are  occupied  in  this  way,  they 
are  called  upon  to  fight  a  great  and  long-drawn-out 
battle  with  the  tubercle  enemy,  it  is  not  surprising 
that  they  have  great  difficulty  in  carrying  out,  at 
one  and  the  same  time,  this  work  of  picking  up 
the  little  fat  globules  and  stoking  them  into  the 
body,  and  of  holding  back  the  enemy  in  the  lungs 
or  elsewhere.  You  can  understand  that  the  more 
you  get  up  steam,  in  other  words,  the  more  you 
exercise,  the  greater  will  be  the  amount  of  fuel 
consumed,  and  consequently  the  greater  will  be  the 
demand  for  stoking. 

In  tuberculosis  much  of  the  enemy's  poison 
gets  into  the  blood,  so  that  both  the  white  cells 
and  the  stomach  wall  cells  are  rendered  toxic,  or 
dopy,  and  cannot  therefore  be  expected  to  carry 
out  their  work  with  the  vigor  and  exactitude  that 
they  do  in  days  of  peace.  Thus  there  is  liable  to 
be  a  failure  somewhere — either  the  enemy  will  not 
be  properly  held  back,  or  the  carrying-in  of  the 
food  will  simply  have  to  be  left  undone.  Perhaps 
there  will  be  a  compromise,  and  the  enemy  will  be 
allowed  to  gain  just  a  little  ground  while  the  body 
is  allowed  to  go  just  a  little  short  of  its  food  supply. 
Is  it  to  be  wondered  at  that,  in  days  of  war,  the 
absorbing  cells  of  the  stomach  wall  become  so 
utterly  tired  and  toxic  that  they  refuse  to  work? 
Yet  when  this  happens,  as  it  does  at  one  time  or 
another  in  the  case  of  from  70  to  90  per  cent,  of 
all  tuberculous  patients,  how  many  of  the  latter  there 
are  who  think  only  of  medicines  and  stontach 
tonics  to  cure  their  indigestion,  while  rest — the  one 


l6o  THE  BATTLE  WITH  TUBERCULOSIS 

rational  and  most  likely  cure — is  never  thought  of  1 
Generally  speaking,  the  slowing  down  of  the  human 
engine  in  order  that  the  necessity  for  fuel  may  be 
limited,  that  the  enemy's  ammunition  or  poison 
may  be  restricted,  and  that  the  stokers  may  be 
given  a  comparative  rest,  is  all  that  is  necessary 
to  restore  the  stomach  to  normal  activity. 

The  steam  locomotive  gives  the  highest  grade 
of  efficiency  as  a  working  machine  when  it  is  sup- 
plied with  fuel  that  will  burn  well,  and  which  will 
produce  a  high  standard  of  heat.  In  the  same  way, 
the  body  is  unable  to  perform  its  best  work  when 
a  poor  grade  of  food,  which  produces  but  little 
heat  and  energy,  is  consumed.  Certain  foods 
might  well  be  compared  to  coke,  in  that  they  afford 
but  little  heat  and  energy,  while  others  are  of  the 
class  of  anthracite  coal.  The  latter  are  the  kinds 
of  food  that  should  be  selected  by  the  tuberculous 
patient  so  that  a  maximum  of  energy  may  be  sup- 
plied at  a  time  when  it  is  much  needed  by  the  forces 
of  defence.^ 

The  tender  of  a  locomotive  carries  the  surplus 
supply  of  fuel  to  be  drawn  upon  as  necessary.  In 
the  human  engine  th^  excess  supply  of  fuel  or  food 
is  reduced  to  fat,  and  is  stored  under  the  skin  and 
in  many  corners  and  crevices  of  the  body.  On  all 
emergencies,  or  at  times  when  the  supply  of  fuel 
does  not  come  up  to  the  demand,  this  reserve  of 
fat  is  called  upon.  You  can  thus  readily  under- 
stand that  if  you  continually  over-exercise,  the 
reserves  of  fat  will  be  so  constantly  required  to 

'  The  foods  of  greatest  value  in  tuberculosis  are  outlined  in 
Chapter  XVI. 


THE  FIGHTING  MACHINE  i6i 

supply  the  energy  expended,  that  there  will  be  no 
possibility  of  storing  up  a  reserve,  or  of  ''  putting 
on  weight." 

The  ordinary  locomotive  could  not  possibly  con- 
sume and  make  use  of  the  fuel  that  is  supplied  to 
it,  were  it  not  for  the  draught  of  air  which  reaches 
the  fire-box  and  supplies  the  oxygen  necessary 
for  consumption.  Moreover,  if  the  smoke  and 
gases  which  result  from  the  combustion  could  not 
escape  through  the  smokestack,  the  fire  would  soon 
become  stifled  and  refuse  to  burn.  Perhaps  you  are 
unaware  that  it  is  impossible  for  you  to  move  your 
finger,  for  your  heart  to  beat  a  single  beat,  or  for 
you  to  even  think  a  thought  without  there  being 
an  actual  combustion  or  explosion,  of  course,  a 
very  diminutive  one,  in  the  particular  tissue, 
muscle,  or  brain  where  the  activity  takes  place. 
This,  in  part,  accounts  for  the  fact  that  you  become 
warm  when  you  exercise.  Further,  this  combus- 
tion requires  its  draught  of  oxygen,  and  gives  off 
its  gas,  just  as  does  the  combustion  in  the  fire-box 
of  the  locomotive.  You  furnish  the  oxygen  in 
the  air  which  your  bellows,  or  lungs,  draw  into 
your  body;  but  just  as  it  is  one  thing  to  put  food 
into  your  stomach,  and  quite  another  for  the 
stomach  wall  cells  to  have  to  stoke  it  load  by  load 
into  the  body,  so  it  is  one  thing  to  draw  the  air  into 
your  lungs  and  quite  another  and  much  greater 
task  to  separate  the  oxygen  out  of  that  air  and  to 
carry  it  to  every  part  of  the  body.  This  is  the 
work  of  the  red  cells,  the  most  important  ally  of 
the  white  cells,  and  day  and  night  without  ceasing 
they  travel  with  load  after  load  of  oxygen  to  every 
II 


i62  THE  BATTLE  WITH  TUBERCULOSIS 

minute  part  of  your  body,  from  the  crown  of  your 
head  to  the  tips  of  your  toes.  More,  they  waste  no 
time  by  returning  empty-handed,  but  on  their  way 
back  to  the  lungs  come  laden  with  gas — the  carbonic 
acid  gas — which  is  given  off  from  the  fire  of  life. 

The  lungs  may  very  aptly  be  called  the  receiving 
and  delivering  station  of  the  red  cells,  and  could 
the  surfaces  where  these  little  workers  take  on 
their  load  of  oxygen  and  throw  off  their  load  of  gas 
be  spread  out  and  carefully  joined  together,  they 
would  cover  an  area  of  over  two  thousand  square 
feet.  In  days  of  peace,  the  fire  of  the  human 
engine  may  keep  up  high  pressure  all  day  long,  and 
the  little  red  cells  work  with  such  precision  that 
the  fire-box  will  be  well  supplied  with  oxygen  and 
there  be  no  stagnation  of  the  gas  which  is  given 
off.  And  so  one  feels  the  joy  of  living.  But  when 
the  tuberculosis  germ  invades  the  lung,  many  of 
the  receiving  and  delivering  stations  of  the  red 
cells  are  destroyed,  and,  if  the  enemy  has  made 
extensive  inroads,  the  oxygen-receiving  station  is 
so  reduced  in  size  that  the  human  engine  is  unable 
to  get  up  enough  steam  to  work  at  high  pressure. 
Further,  as  the  poison  of  the  enemy  gets  into  the 
blood,  it  often  destroys  many  of  the  red  cells,  as 
well  as  interferes  with  them  in  their  work.  Thus 
there  are  fewer  workers  to  accomplish  more  than 
ordinary  work,  and  the  environment  is  no  longer 
conducive  to  energy  and  enthusiasm. 

The  result  of  all  this  is  that  the  reduced  number 
of  workers,  working  with  a  limited  source  of  suj>- 
ply,  have  to  travel  faster,  and  whereas  formerly 
they  could  meet  the  demand  in  a  normal  nimiber  of 


THE  FIGHTING  MACHINE  163 

trips  per  hour,  they  now  have  to  greatly  increase  the 
number  of  their  journeys  in  order  to  accomplish  the 
work  even  in  an  imperfect  manner.  But  the  heart 
is  the  pump  which  sends  them  on  their  rounds,  and 
if  they  are  to  travel  faster,  the  heart  has  to  pump 
faster.  So  it  is  that  the  heart  or  pulse  of  the  tuber- 
culous patient  beats  more  quickly  than  normally, 
and  requires  very  little  in  the  way  of  over-exercise 
to  make  it  run  riot.  It  is  not  surprising  that  when 
the  man  with  tuberculosis  undertakes  more  exer- 
cise than  he  ought  to,  when  he  tries  to  get  up  over- 
much steam,  there  follows  a  hunger  for  air,  with 
fast  breathing,  and  blueness  of  the  finger-nails 
and  lips. 

Then  there  is  the  other  side.  If  the  red  cells 
have  difficulty  in  picking  up  sufficient  oxygen,  they 
have  just  as  much  difficulty  in  getting  rid  of  their 
loads  of  carbonic  acid  gas.  Thus  the  human  engine 
becomes  partially  stifled,  the  fire  burns  less  brightly, 
and  the  wheels  drag.  In  view  of  all  this,  you  must 
surely  realize  the  folly  of  remaining  in  any  place 
except  where  the  air  is  as  pure  as  crystal;  you 
must  surely  see  that  to  continually  remain  indoors, 
even  if  you  have  fair  ventilation,  is  to  impose  a 
handicap  on  your  red  cells  that  may  suffice  to  make 
them  lose  in  their  battle  against  the  tubercle  enemy. 
Finally,  the  locomotive  has  its  ashes,  which  have 
to  be  kept  cleared  out  of  the  fire-box,  or  they  will 
interfere  with  the  draught,  stifle  the  fire,  and 
greatly  restrict  the  running  capacity  of  the  engine. 
Just  in  the  same  way  the  human  engine  has  its 
ashes  which  have  to  be  constantly  gathered  from 
every  remote  part  of  the  body,  and  have  to  be 


164  THE  BATTLE  WITH  TUBERCULOSIS 

carried  to  the  lungs,  the  kidneys,  the  bowels,  and 
the  skin,  where  they  are  sifted  and  the  useless  parts 
thrown  out  of  the  body.  There  is  probably  no 
factor  more  accountable  for  illness  than  the  con- 
stant presence  in  the  body  of  poisonous  ashes  which 
should  be  removed.  In  the  case  of  the  locomotive, 
the  fire  may  be  allowed  to  die  and  a  thorough 
cleaning  out  of  the  ashes  may  be  instituted.  But 
in  the  human  engine  the  fire,  once  out,  is  out 
forever,  hence  the  sifting  of  the  ashes  must  be 
accomplished  while  the  fire  burns  on. 

Most  of  the  work  of  gathering  up  waste  from 
all  parts  of  the  body  is  performed  by  the  white 
cells.  Besides  being  the  warriors,  they  are  often 
called  "the  phagocytes,"  or  scavengers.  When 
the  human  engine  is  invaded  by  the  tubercle  enemy, 
the  vital  fire  of  peaceful  days  is  eclipsed  by  the 
conflagration  of  the  battlefield,  and  the  economy 
of  peace  becomes  the  enormous  waste  of  war.  You 
have  seen  that  the  pus  in  the  sputum  is  composed 
of  billions  of  bodies  of  dead  white  cells.  When 
you  consider  that  hour  after  hour  you  are  bringing 
up,  and  casting  from  your  body,  such  inconceivable 
numbers  of  these  little  warriors  so  badly  needed 
to  carry  on  the  extra  work,  is  it  to  be  wondered 
at  that  some  of  the  poisonous  debris  of  battle  is 
overlooked  and  produces  in  your  body  fever  and 
"toxaemia"  or  poisoning?  So  you  must  assist 
all  you  can  in  keeping  the  ash-sifters  of  your  body 
from  becoming  clogged.  Plenty  of  pure  water  for 
the  kidneys,  careful  regularity  in  evacuating  the 
bowels,  daily  cleansing  rubs  for  the  skin,  and, 
above    all,    the    avoidance    of    over-tiring    the 


THE  FIGHTING  MACHINE  165 

scavengers,  are  a  few  of  the  obvious  indications. 
When  one  considers  the  many  serious  handicaps 
which  are  imposed  upon  the  white  cells  and  their 
allies,  through  the  invasion  of  the  human  engine 
by  the  tubercle  enemy,  it  is  not  unnatural  that 
many  a  patient  should  feel  that  the  outlook  is  hope- 
less. This  is  not  so,  however,  as  an  experiment, 
performed  by  the  great  physiologist,  Starling, 
demonstrated.  He  selected  a  healthy,  muscular 
man  trained  to  heavy  exercise,  had  him  on  one 
occasion  rest  quietly  for  fifteen  minutes,  on  another 
do  moderate  work  for  fifteen  minutes,  and  upon  a 
third  do  severe  work  for  fifteen  minutes.  During 
each  period  he  ascertained  exactly  how  much  oxy- 
gen the  man  required,  how  much  carbonic  acid 
gas  he  breathed  out,  and  how  many  times  his  heart 
beat  per  minute.  The  following  table  shows  the 
results.^ 

Oxygen         Carbonic  acid    Heart-beats 

absorbed  per      gas  given  off     or  pulse-rate 

minute  per  minute        per  minute 

1.  Lying  quietly  at  rest 243  200  56 

2.  Doing  moderate  work..   1,834  1.720  156 

3.  Doing  severe  work 3,265  2,227  ^66 

Without  considering  severe  work,  as  you  are 
unlikely  to  attempt  that,  you  will  note  that  the 
healthy  man  requires,  roughly,  seven  and  a  half 
times  as  much  oxygen  while  exercising  as  while 
lying  quiet;  that  he  has  to  get  rid  of  just  eight 
and  a  half  times  as  much  carbonic  gas  while  exer- 
cising as  while  lying  quiet ;  and  finally  that  his  heart 
has  to  beat  nearly  three  times  as  fast  while  exercis- 
ing as  while  lying  quiet.     Starling  has  also  shown 

*  Starling's  "  Human  Physiology,"  page  640. 


166  THE  BATTLE  WITH  TUBERCULOSIS 

in  another  experiment  that  practically  twice  as 
much  food  or  fuel  is  consumed  by  a  man  when  he 
is  exercising  as  when  he  is  resting.  All  of  this 
holds  good  in  the  case  of  a  healthy  man  with  a 
perfectly  running  engine,  but  consider  for  a 
moment  the  case  of  the  man  with  a  crippled  engine 
— an  engine  which  is  burning  two  fires,  one  in  the 
fire-box  and  another  in  the  ventilator.  Two  fires 
require  more  oxygen  than  one;  two  fires  give  off 
much  more  gas  than  one,  and  two  fires  require 
more  fuel,  more  stoking,  and  more  gathering  of 
ashes,  and  the  crippled  engine  is  less  able  to  supply 
any  one  of  them.  Also  the  faster  the  engine  runs, 
the  more  furiously  must  both  fires  burn,  and  not 
only  must  the  engine  be  tended  in  every  depart- 
ment, but  a  fierce  and  long-drawn-out  battle  must 
be  fought  at  the  same  time. 

The  path  of  victory  is  rest.  Surely  you  can 
realize  the  foolishness  of  making  the  fire  burn  more 
furiously  than  is  necessary,  of  trying  to  get  up 
steam  when  the  little  workers  in  the  human  engine 
are  distracted  beyond  measure  by  the  desperate 
struggle  they  are  waging  against  death.  Even  if 
indifferent  to  your  chances  of  survival,  surely  your 
love  of  fair  play  and  your  sense  of  chivalry  will 
make  you  give  to  your  soldiers  of  defence  the 
right  to  fight  their  battle  unhampered  by  the  folly 
of  pleasure-seeking  and  the  curse  of  indulgence! 


CHAPTER  XIX 
Good  Generalship 

There  are  many  men  and  women  who  have 
been  fighting"  the  battle  against  the  tubercle  enemy 
for  months  and  even  years,  who  ardently  desire 
to  follow  the  treatment  as  it  should  be  followed 
but  who  realize  that  there  Is  an  indefinable  some- 
thing or  lack  of  something  in  their  make-up  which 
causes  them  to  fall  short  of  their  aim.  They 
know  the  right  treatment  because  they  constantly 
see  before  them  other  patients  who  carry  it  out, 
and  for  the  first  part  of  the  day  they  themselves 
succeed  very  well,  but  before  the  evening  shadows 
lengthen  into  night,  something  unforeseen  seems 
always  to  arise  to  interfere  with  a  complete  day, 
which  is  what  really  counts.  If  recovery  depended 
only  on  doing  some  big  task,  these  patients  would 
work  the  flesh  off  their  fingers  in  the  effort  at 
achievement,  but  because  victory  depends  on  renun- 
ciation, or  doing  practically  nothing,  one  out  of 
every  two  is  vanquished  in  the  conflict.  Why  is 
this? 

Professor  Carpenter  answers  the  question  very 
well  when  he  says :  "  Our  nervous  systems  have 
grown  to  the  way  in  which  they  have  been  exercised 
just  as  a  sheet  of  paper  or  a  coat  once  creased 
or  folded  tends  to  fall  forever  afterwards  into 
the  same  identical  folds."  Again,  as  Professor 
William  James  writes :     "  Ninety-nine  one-hun- 

167 


l68  THE  BATTLE  WITH  TUBERCULOSIS 

dredths  or  nine  hundred  and  ninety-nine  one-thou- 
sandths of  our  activity  is  purely  automatic  and 
habitual."  All  your  life,  previous  to  your  illness, 
your  training  has  been  positive,  has  been  to  act, 
and  the  more  activity  the  better;  it  has  not  been 
to  sit  still  v^ith  folded  hands.  You  are  quite  in 
the  habit  of  obeying  your  positive  commands,  but 
are  you  in  the  habit  of  exercising  self-denial? 
Lifelong  habit  is  not  changed  in  a  day,  or  a 
month,  or  even  in  a  year,  and  if  in  our  early  days 
we  have  not  had  the  habit  of  obedience  ingrained, 
if  we  have  not  been  made  to  obey  our  parents,  it 
is  doubtful  if  in  the  present  we  will  be  able  to  obey 
ourselves.  But  recovery  from  tuberculosis  depends 
to  a  very  great  extent  on  implicit  obedience  to  one's 
own  commands,  and  if  in  the  past  you  have  not 
learned  to  obey  your  own  highest  dictates,  it  is 
wise  that  you  should  institute  a  course  in  self -train- 
ing without  further  delay. 

First  of  all,  do  not  deceive  yourself  with  the 
idea  that  you  can  follow  your  own  commands  in 
any  great  test,  if  you  cannot  be  obedient  to  yourself 
in  the  little,  apparently  trivial  things.  For  ex- 
ample, if  you  have  not  enough  self-control  to  make 
yourself  lie  quiet  for  an  hour  without  amusing  or 
entertaining  yourself  in  some  way,  it  is  not  to 
be  wondered  at  if  you  fall  an  easy  prey  to  seduc- 
tive enjoyments.  Start  training  yourself  on 
little  things,  even  though  they  do  not  demand  self- 
control;  in  other  words,  exercise  self-control  in 
little  things  simply  for  self-control's  sake.  For 
example,  the  porter  leaves  on  your  table  a  letter 
from  home  the  contents  of  which  you  are  most 


GOOD  GENERALSHIP  169 

anxious  to  enjoy.  There  is  no  reason  why  you 
should  not  read  the  letter,  other  than  that  it  affords 
an  opportunity  for  practising  self-control.  Com- 
mand yourself  to  let  it  He  for  half  an  hour  or  an 
hour.  Such  commands  faithfully  and  frequently 
carried  out  provide  that  something  in  your  make- 
up the  absence  of  which  is  the  cause  of  many  a 
man  losing  his  battle  against  tuberculosis. 

Try  and  develop  an  analytical  mind — the  type 
of  mind  that  is  constantly  dissecting  with  the 
purpose  of  arriving  at  the  truth  with  respect  to 
statements  of  others  and  particularly  your  own 
statements,  thoughts,  and  actions.  You  have  prob- 
ably discovered  that  to  ascertain  or  speak  the 
truth,  the  whole  truth,  and  nothing  but  the  truth 
about  anything  is  most  difficult.  The  reason  is 
that  people  constantly  refrain  from  calling  a  spade 
a  spade,  and  insist  on  calling  it  a  garden  implement 
or  something  else  equally  indefinite.  When  you 
succumb  to  a  quiet  game  of  poker,  or  slip  off  down 
town  when  you  should  be  in  bed  and  asleep,  do 
not  call  it  "  just  a  little  fun  " ;  analyze  it  carefully 
and  you  will  be  sure  to  label  it  "  damn  folly." 
Likewise,  do  not  allow  rank  dissipation  to  mas- 
querade under  a  colloquialism  such  as  that  of 
"  being  a  good  sport."  Do  not  excuse  your  over- 
indulgence in  the  pleasures  of  life  with  soothing 
words  to  the  effect  that  once  in  a  while  one  has 
to  do  something  to  break  the  monotony.  Every 
one  must  learn  to  be  rigidly  honest  with  himself, 
and  always  be  his  own  most  exacting  critic  and 
taskmaster. 

There  are  many  actions  which  our  Inner  con- 


I70  THE  BATTLE  WITH  TUBERCULOSIS 

sciousness  whispers  to  us  are  unwise,  but  we  do 
not  stop  and  listen,  because  many  of  us  are  so  con- 
stituted that  we  prefer  to  ride  rough-shod  over 
anything  which  interferes  with  our  pleasure,  or 
is  unpleasant  to  think  about.  You  have  probably 
noticed,  as  we  all  have,  that  it  is  in  the  stern,  calm 
light  of  the  "  morning  after  "  that  your  inmost  con- 
science sometimes  refuses  to  be  obliterated.  It  is 
then  that  it  is  wise  to  thresh  the  matter  out  to  the 
bitter  end.  If  you  procrastinate,  there  is  some- 
thing so  alluring  about  the  shadows  of  evening 
that,  with  their  approach,  the  morning's  whisper- 
ings become  drowned  in  dreamy  anticipation  of 
pleasure.  In  the  morning,  we  can,  to  some  extent, 
put  away  impulse  and  desire,  and  realize  that  per- 
haps Death  was  lurking  in  the  shadows  of  the  even- 
ing before.  In  the  morning,  reason  is  liable  to  be 
uppermost,  so  it  is  then  that  we  must  analyze  our 
actions  and  decide,  in  no  indefinite  manner,  what 
our  future  course  is  to  be. 

We  have  all  made  resolutions  and  we  have  all 
broken  them,  but  there  are  some  steps  we  may  take 
which  will  fortify  us  in  our  resolves.  In  the  first 
place,  a  resolution,  if  it  is  to  be  adhered  to,  must  in 
no  way  be  conditional  on  something  else.  It  must 
be  intensely  earnest — so  earnest  that  we  become 
willing  to  place  ourselves  in  a  position  in  which 
we  shall  feel  decidedly  ashamed  if  we  do  not  carry 
out  the  resolve.  This  is  accomplished  by  telling 
others  about  it,  by  writing  home  about  it,  by  con- 
fiding it  to  the  doctor,  by  committing  ourselves  to 
it  in  every  possible  manner.  Professor  William 
James  illustrates  this  very  beautifully  in  one  of  his 


GOOD  GENERALSHIP  171 

books.*  He  writes :  "  I  remember  long  ago  read- 
ing in  an  Austrian  paper  the  advertisement  of  a 
certain  Rudolph  Somebody,  who  promised  fifty 
gulden  reward  to  anyone  who  after  that  date  should 
find  him  at  the  wine  shop  of  Ambrosius  So-and-so. 
*  This  I  do,'  the  advertisement  continued,  'in  con- 
sequence of  a  promise  which  I  have  made  my  wife.' 
With  such  a  wife  and  such  an  understanding  of 
the  way  in  which  to  start  new  habits,  it  would  be 
safe  to  stake  one's  money  on  Rudolph's  ultimate 
success." 

Once  a  resolution  is  made,  no  time  should  be  lost 
in  carrying  it  into  effect.  For  example,  you  may 
have  come  to  the  conclusion  that  the  right  thing  for 
you  to  do  is  to  go  to  bed  immediately  after  supper, 
in  order  to  prevent  the  over-exercising  that  is  so 
liable  to  take  place  during  the  evening  hours  of 
recreation.  Suppose  this  conclusion  to  be  reached 
on  Friday,  it  would  be  utter  folly  to  put  off  carry- 
ing it  out  until  Monday. 

There  are  very  few  rules  which  do  not  have  their 
exceptions,  but  your  resolution,  in  addition  to  being 
earnest,  must  be  absolute.  There  must  be  no  special 
occasions  upon  which  the  resolve  is  suspended — 
no  "  just  for  to-nights."  Once  the  resolution  is 
broken,  it  undoes  the  good  accomplished  during  at 
least  five  occasions  on  which  the  resolve  has  been 
successfully  carried  out,  and,  on  the  other  hand, 
every  time  it  is  put  into  effect  it  greatly  diminishes 
the  resistance  it  is  necessary  to  overcome  to  fulfil 
it  on  the  next  occasion.     It  gradually  becomes  a 

* "  Talks  on  Psychology  and  Life's  Ideals,"  page  68. 


172  THE  BATTLE  WITH  TUBERCULOSIS 

habit,  and  then  the  temptation  to  omit  carrying  it 
out  is  practically  nil. 

Scarcely  a  day  goes  by  in  the  tuberculosis  battle 
that  some  little  thing  does  not  arise  which  requires 
thought,  patience,  and  determination.  Sometimes 
the  temptation  is  very  strong  to  shift  the  responsi- 
bility to  other  shoulders,  and  make  some  one  else 
decide  on  a  point  which  we  realize  should  be  de- 
cided in  only  one  way.  Some  one,  for  example,  has 
extended  you  an  invitation  to  a  theatre  party,  and 
immediately  there  follows  a  conflict  between  reason 
and  desire.  Reason  tells  you  that  you  are  not  in 
fit  condition  for  such  excitement,  but  instead  of 
having  sufficient  grit  to  make  the  decision  for  your- 
self, you  put  it  up  to  the  doctor  with  a  vague  hope 
that  perhaps,  out  of  the  kindness  of  his  heart,  he 
will  let  you  go.  Once  having  gained  his  permis- 
sion, your  own  good  sense  in  the  matter,  and  your 
knowledge  that  the  doctor  has  been  imprudent,  are 
effaced  by  the  thought  that  he  is  to  blame  if  any- 
thing goes  wrong.  Such  tactics  indicate  very  poor 
generalship,  because  a  battle  lost  is  a  battle  lost, 
and  it  matters  little  who  is  to  blame.  Such  con- 
flicts between  desire  and  reason  must  be  decided 
immediately  and  not  put  oflf  for  consideration, 
otherwise  reason  will  invariably  be  overcome  by 
desire.  Indeed,  even  after  reason  has  won  the 
battle,  desire  will  often  lurk  around  begging  for 
further  consideration  and,  unless  summarily  dis- 
missed, may  become  threatening. 

It  is  well  that  you  should  lay  down  rules  for 
yourself  on  many  of  the  everyday  little  things 
which  in  themselves  seem  insignificant,  but  which 


GOOD  GENERALSHIP  173 

taken  together  often  determine  the  destiny  of  the 
battle.  For  example,  you  have  noticed  a  tendency 
to  interest  yourself  in  something  in  y6ur  room  just 
after  meals,  so  that  you  always  lose  ten  to  fifteen 
minutes  in  getting  down  to  business.  No  one 
would  think  of  finding  fault  with  you  for  this 
trifling  delinquency,  and  unless  you  are  very  much 
in  earnest  in  the  business  of  getting  well,  you  will 
probably  never  take  yourself  to  task  for  it.  But 
fifteen  minutes  after  each  meal  amounts  to  twenty- 
two  hours  in  a  month,  and  it  is  possible  to  take 
a  great  deal  of  over-exercise  in  twenty-two  hours. 
Clearly,  here  is  an  opportunity  to  legislate  on  your 
own  behalf. 

Another  example  may  be  helpful.  In  winter 
time  the  question  constantly  arises  as  to  whether 
or  not  it  is  too  cold  to  lie  outside,  and  frequently 
the  decision  is  based  on  your  own  feelings  rather 
than  on  the  actual  reading  of  the  thermometer. 
Here  is  an  opportunity  to  lay  down  a  definite  law 
for  yourself.  You  will  go  out  when  the  tempera- 
ture is  not  lower  than,  let  us  say,  zero,  or  ten  above 
or  even  fifteen  above  zefo.  The  point  is  not  what 
the  temperature  should  be,  because  your  doctor  will 
determine  that,  but  that  you  should  have  a  clear 
understanding  with  yourself  as  to  when  you  go  out- 
of-doors,  and  when  you  stay  inside. 

Finally,  good  generalship  consists  not  only  in 
possessing  a  clear  understanding  and  objective,  in 
enforcing  rigid  discipHne,  in  self-reliance,  and  act- 
ing in  accord  with  reason,  but  the  most  successful 
general  is  the  one  possessed  of  enthusiasm  and 
optimism,  one  who  is  going  to  win  the  battle,  no 


174  THE  BATTLE  WITH  TUBERCULOSIS 

matter  what  the  odds.  Never  allow  a  word  of 
doubt  to  escape  your  lips,  and  as  for  pessimistic 
reminiscences,  remember  Browning's  words: 

"  But  how  carve  way  i'  the  life  that  lies  before, 
If  bent  on  groaning  ever  for  the  past?" 

The  secret  of  being  enthusiastic  is  to  practise  in- 
stilling enthusiasm  into  others.  Cheer  and  en- 
courage the  other  fellow  all  you  can,  and  tell  the 
friends  at  home  that  if  they  cannot  write  cheerful 
and  encouraging  letters  they  would  be  wiser  not 
to  write  at  all.  To  continually  assert  that  you  are 
going  to  recover,  is  to  come  in  time  to  feel  that  you 
are  getting  well,  and  to  feel  that  you  are  getting 
well  is  a  wonderful  help  in  your  fight.  You  must 
carry  yourself  along  with  your  own  enthusiasm. 
Nothing  wins  like  success.  Remember  that  though 
it  seems  very  difficult  at  times  to  be  enthusiastic 
and  optimistic,  everything  is  difficult  that  is  not  a 
habit.  Single  acts  become  easier  with  each  repeti- 
tion imtil  finally  they  become  habits,  and  habits  in 
turn  mould  character.  Those  who  follow  the  line 
of  least  resistance  will  develop  habits  in  accord  with 
pleasure,  and  their  characters  will  remain  mediocre 
or  feeble,  and  those  who  go  against  the  current  of 
their  own  harmful  tendencies,  and  thoughtfully 
develop  habits  which  have  a  definite  high  objective, 
will  gain  for  themselves  the  greatest  of  all  rewards, 
the  ability  to  be  what  one  wills. 


CHAPTER  XX 
Special  Weapons 

In  the  light  of  modern  research  it  is  difficult  to 
believe  that  there  still  remain  intelligent  people  who 
proclaim  that  they  do  not  believe  in  the  "  germ 
theory."  Science  does  not  seek  to  force  itself  upon 
skeptical  minds,  but  we  must  realize  that,  while  a 
healthy  individual  can  afford  to  scoff  at  germs  to 
his  heart's  content,  there  is  an  element  of  consider- 
able danger,  not  to  mention  a  positive  handicap, 
in  such  skepticism,  on  the  part  of  a  tuberculous 
patient.  Disbelief  in  a  great  scientific  fact  is  gen- 
erally synonymous  with  ignorance  of  the  proof. 
But  disbelief  in  the  germ  causation  of  certain  dis- 
eases can  no  longer  survive  a  knowledge  of  facts 
such  as  the  following. 

After  years  of  labor  and  painstaking  investiga- 
tion, scientists  have  succeeded  in  isolating  disease 
germs  from  their  home  in  the  animal  body,  and  in 
growing  them  in  broth,  gelatine,  blood-serum,  and 
in  many  other  media.  They  have  succeeded  in 
separating  them  into  pure  cultures,  i.e.,  in  growing 
one  variety  of  germ  alone  by  itself,  and  uncon- 
taminated  by  any  other  type.  Thus  anthrax,  diph- 
theria, tubercle,  typhoid,  and  many  another  germ 
may  be  separated  out  In  different  individual  recep- 
tacles, and  labelled,  and  the  scientist  can  predict 
with  absolute  certainty  the  symptoms  and  the  dis- 

175 


176  THE  BATTLE  WITH  TUBERCULOSIS 

case  that  inevitably  will  follow  the  injection  of  any 
one  of  these  pure  cultures  into  an  animal  body. 

Further,  it  is  possible  to  separate  the  poison  pro- 
duced by  a  germ  from  the  living  germ  itself,  so 
that,  for  example,  by  injecting  only  the  poison  of 
the  diphtheria  germ  into  the  body,  all  of  the  symp- 
toms of  diphtheria  appear  for  a  short  time,  but 
disappear  just  as  soon  as  the  poison  is  excreted 
from  the  body.  There  being  no  germs  present,  the 
poison  does  not  continue  to  be  manufactured.  It 
is  the  poison  of  the  germ,  and  not  the  germ  itself, 
which  is  the  direct  cause  of  symptoms.  The  poison 
of  a  tubercle  germ,  separated  from  the  bacillus 
itself,  is  capable  of  producing  tubercles,  fever, 
emaciation,  etc.  Of  course,  it  is  possible  to  give 
such  a  large  dose  of  germ  toxin  that,  in  itself,  it 
would  cause  death.  The  effect  upon  animals 
varies;  some  can  stand  large,  others  only  small 
doses,  at  one  time.  The  rabbit,  for  example,  can 
stand,  per  body  weight  unit,  two  thousand  times 
more  tetanus  toxin  than  the  guinea-pig,  and  the 
hen  can  stand  ten  times  more  than  the  rabbit.  But 
the  very  wonderful  and  useful  fact  has  been  dis- 
covered that  the  second  dose  of  toxin  is  borne  very 
much  more  easily  than  the  first,  and,  in  fact,  that 
the  second  dose  may  be  made  considerably  larger 
than  the  first.  Further,  the  third  injection  may  be 
made  larger  again,  and  so  on  until  finally  the  animal 
can  stand  a  dose  large  enough  to  kill  ten  such 
animals  which  have  never  received  toxin.  What 
does  all  this  mean? 

When  the  first  dose  of  toxin  circulates  among 
the  white  cells  and  their  allies,  these  little  soldiers 


SPECIAL  WEAPONS  177 

are  naturally  led  to  believe  that  an  invasion  is 
imminent,  so  they  proceed  to  manufacture  a  vari- 
ety of  ammunition  that  tends  to  neutralize  and 
combat  the  poison  of  the  enemy.  The  taste  of 
the  toxin  to  the  white  cells  is  something  like  the 
first  taste  of  blood  to  a  tiger.  It  not  only  makes 
them  keen  and  watchful  for  the  enemy,  but  it 
actually  whets  their  appetites  and  improves  their 
digestions,  so  that  after  they  have  been  given 
many  doses  of  the  toxins,  should  the  germs  them- 
selves be  injected,  the  white  cells  and  their  allies 
would  annihilate  them  with  ease.  But  here  the 
old  adage  that  "  Enough  is  as  good  as  a  feast " 
applies.  To  get  the  best  results,  just  the  right 
amount  of  toxin  must  be  injected.  Too  much 
will  lead  to  "toxaemia,"  or  drunkenness.  When 
the  germs  are  not  in  the  body,  drunkenness  on  the 
part  of  the  white  cells  and  their  allies  may  be  re- 
covered from,  but,  when  the  germs  are  present,  it 
puts  them  in  a  very  precarious  position. 

The  enemy  hosts  of  the  germ  kingdom  may  be 
divided  into  two  classes,  according  to  the  manner 
in  which  their  ammunition  is  prepared.  The  germ 
belonging  to  the  first  class  may  be  compared  to  a, 
snake  or  spider  in  that  it  manufactures  its  poison 
within  its  body,  and  spits  it  out,  or  excretes  it,  into 
the  blood  of  its  victim.  As  respects  the  germ  of 
the  second  class,  it  is  the  body  of  the  germ  itself 
which  contains  in  its  consistency  the  dreaded  toxin, 
and  it  is  probably  not  until  the  germ  is  dead  and 
disintegrated  that  his  poisonous  character  is  dis- 
closed. The  tubercle  bacillus  belongs  to  the  second 
12 


178  THE  BATTLE  WITH  TUBERCULOSIS 

type,  while  the  diphtheria  germ  is  a  prominent 
member  of  the  class  which  excretes  its  poison. 

Sera  are  prepared  from  the  blood  of  animals 
treated  with  the  poisons  excreted  by  certain  germs, 
while  vaccines  are  solutions  containing  the  dead  or 
very  weak  bodies  of  germs  of  the  class  which  do  not 
excrete  toxin  but  which  contain  it  in  their  body 
substance.  Tuberculin  is  really  a  broth  of  tubercle 
bacilli  standardized  to  a  certain  strength.  For  years 
it  has  been  the  hope  of  scientists  that  by  giving 
tuberculin  to  little  children,  starting  with  minute 
doses  and  gradually  increasing  them,  the  armies  of 
defence  in  the  children  thus  treated  would  become 
so  strong,  so  resistant,  that  they  would  speedily  anni- 
hilate any  tubercle  bacilli  that  might  attempt  an 
invasion.  The  results,  however,  up  to  the  present 
have  not  been  encouraging.  Though  Koch,  who 
discovered  tuberculin  in  1890,  very  much  overrated 
its  value  in  the  treatment  of  tuberculosis,,  it  has 
nevertheless  been  given  to  a  selected  group  of 
tuberculous  patients  with  gratifying  results.  It 
should  be  clearly  understood  that  it  is  of  advantage 
only  in  certain  cases,  and  that  a  considerable 
amount  of  expertness  is  required  on  the  part  of 
the  doctor  in  determining  which  patients  should 
receive  tuberculin  treatment,  and  in  administering 
the  toxin.  Certainly,  as  regards  these  points,  a 
patient  is  in  no  position  to  judge  for  himself. 

Generally  speaking,  cases  which  are  progressing 
favorably,  and  cases  which  are  already  over- 
whelmed with  the  poison  of  the  tubercle  enemy 
should  be  left  alone.  On  the  other  hand,  patients 
who  have  progressed  favorably  up  to  a  certain 


SPECIAL  WEAPONS  179 

point  and  have  then  become  more  or  less  stationary, 
neither  improving  nor  retrogressing,  need  some- 
thing to  stir  up  their  fighting  forces  to  greater  deeds 
of  valor,  and  tuberculin  carefully  and  scientifically 
administered  oftentimes  proves  a  wonderful  help. 
But,  as  pointed  out  by  Dr.  Sahli,  "  the  qualifica- 
tions of  the  physician  who  administers  it  are  cer- 
tainly of  more  importance  in  most  cases  than  the 
quality  of  the  tuberculin." 

In  a  few  incipient  cases,  tuberculin  may  be  prop- 
erly called  a  specific,  i.e.,  a  preparation  which  is 
really  curative.  It  aims  at  so  improving  the  fight- 
ing power  of  the  white  cells  and  their  allies  that 
they  will  be  able  to  eradicate  the  disease  from  the 
body.  It  is  probably  more  generally  helpful  in 
moderately  advanced  cases  than  in  any  others. 
You  cannot  possibly  judge  of  the  value  of  tuber- 
culin treatment  on  such  evidence  as  that  "  Billy 
Brown  became  worse,"  or  "  Mary  Jones  got  fat " 
after  taking  it.  To  arrive  at  anything  like  a  com- 
prehensive idea  of  its  results,  you  have  to  consider 
the  reports  of  competent  judges  who  have  tested 
its  efficiency  on  a  great  number  of  patients.  Dr. 
Kreuser  selected  a  hundred  :and  ten  cases  who  were 
bringing  up  tubercle  bacilli  in  their  sputum,  and 
while  all  of  the  patients  followed  the  regular  rest 
cure,  he  treated  one-half  of  their  number  with 
tuberculin.  After  a  prearranged  period  had 
elapsed,  it  was  found  that  twenty-two  of  the  fifty- 
five  treated  with  tuberculin  had  ceased  to  raise 
tubercle  bacilli,  while  only  sixteen  of  the  other 
fifty^five  had  got  rid  of  the  tubercle  germs  from 
their  sputum.    This  gives  a  fair  idea  of  what  may 


l8o    THE  BATTLE  WITH  TUBERCULOSIS 

be  expected  in  the  way  of  so-called  cure  by  tuber- 
culin, but,  outside  of  cure,  the  proportion  of  patients 
helped  by  tuberculin  is  very  much  greater. 

After  an  injection  of  tuberculin,  there  is  con- 
siderable bustling  and  excitement  among  the  white 
cells  and  their  allies  around  the  encampments  of  the 
tubercle  enemy.  The  forces  of  defence  become  ex- 
ceptionally busy,  and  you  can  well  realize  that  at 
that  particular  time  it  is  essential  they  should  not 
be  tired,  or  have  their  attention  in  any  way  dis- 
tracted. It  is  most  important  that  during  these 
little  crises,  you  should  make  it  a  point  to  assist 
your  diminutive  soldiers  just  as  much  as  lies  in  your 
power.  Rest  of  mind  and  body  enables  your  forces 
to  give  closer  attention  to  mobilization  and  attack, 
so  rest  should  be  the  watchword.  Should  your 
temperature  reach  the  hundred  mark  for  more  than 
two  hours,  it  is  wise  to  go  to  bed  and  remain  there 
until  the  reaction  has  completely  vanished.  Head- 
ache or  pain  at  the  site  of  injection  may  be  treated 
by  application  of  the  ice-bag  to  the  painful  area, 
and  all  such  symptoms  should  be  recorded  for  the 
doctor's  consideration. 

Perhaps  it  has  never  occurred  to  you  that  during 
the  course  of  your  disease,  each  time  you  exercise, 
you  inoculate  yourself  with  a  small  amount  of  your 
own  tuberculin  which  exists  in  considerable  quan- 
tities at  the  site  of  your  trouble.  Until  such  time 
as  the  enemy  has  been  completely  imprisoned,  every 
little  movement  of  your  body  liberates  a  greater  or 
less  amount  of  poison  of  the  tubercle  germ  into 
your  blood.  Generally,  the  toxin  gets  in  all  too 
freely,  and  makes  you  feel  tired  and  listless,  spoils 


SPECIAL  WEAPONS  i8i 

your  appetite,  and  makes  you  feverish.  Needless 
to  say,  the  greater  the  exertions  of  your  body,  the 
more  freely  does  the  toxin  enter  the  blood,  and  to 
over-exercise  at  a  time  when  the  enemy  is  in  the 
ascendency  is  to  intoxicate  your  army  of  defence. 

When  the  time  comes  that  the  tubercle  bacilli 
are  imprisoned,  and  your  white  cells  and  their  allies 
have  slackened  in  their  efforts  at  routing  the  enemy, 
apparently  having  come  prematurely  to  the  con- 
clusion that  the  battlfe  is  won,  then  is  the  time  that 
just  enough  exercise  to  liberate  a  little  of  the 
enemy's  poison  will  take  the  cock-sureness  out' 
of  the  home  forces,  and  make  them  realize  that  the 
time  has  not  yet  arrived  to  stack  arms.  So  we  see 
that  when  the  right  time  arrives,  exercise  is  just  as 
important  as  rest  was  at  an  earlier  stage.  The  most 
exacting  duty  of  your  medical  adviser  is  to  deter- 
mine when  you  should  exercise,  aind  when  you 
should  rest,  and  what  the  duration  of  each  should 
be.  You  cannot  determine  this  accurately  for  your- 
self, and  it  would  not  be  well  to  try. 

To  the  man  who  is  at  business  all  day,  exercise, 
so-called,  often  consists  in  turning  out  for  a  game 
of  tennis  or  football.  To  the  man  who  has  been  on 
the  flat  of  his  back  for  a  month  or  two,  sitting  out 
of  bed  in  an  easy  chair  is  strenuous  exercise.  To 
you,  it  must  never  mean  anything  more  than  walk- 
ing, walking  soberly  and  sedately  as  a  man  of  sixty- 
five.  Many  a  man  has  put  himself  back  three  to 
six  months,  if  indeed  he  has  not  sacrificed  his  life, 
through  the  single  act  of  running  for  a  street  car. 
Cars  may  come  and  cars  may  go,  trains  may  be 
missed,  and  the  postman  may  go  by  without  your 


I82  THE  BATTLE  WITH  TUBERCULOSIS 

letter,  but  you  must  never  let  your  ambulations 
exceed  the  hemorrhagic  gait.  Perhaps  the  day  will 
come  when  you  may  indulge  in  a  quiet  game  of 
golf,  or  even  something  much  more  strenuous,  but 
for'  the  present  reflect  on  the  building  operations 
which  are  taking  place  in  your  chest,  and  do  not 
risk  breaking  down  the  newly-constructed,  deli- 
cate fibres  which  imprison  the  enemy  and  his  poison. 

While  walking  is  the  outside  limit  of  exercise  for 
the  tuberculous  patient,  one  may  readily  under- 
stand that  were  an  individual,  who  has  had  a  long 
sojourn  in  bed,  to  rise,  dress  and  go  for  a  walk, 
all  at  the  one  time,  it  would  quite  probably  undo 
much  of  the  good  accomplished  by  the  complete 
rest.  Hence,  we  may  determine  several  steps  be- 
tween complete  rest  and  walking.  First  comes 
passive  exercise,  i.e.,  some  one  else  exercising  on 
you,  by  giving  you  massage  or  an  alcohol  rub. 
Next,  you  should  be  able  to  sit  up  in  bed  for  half 
an  hour  without  being  fagged  before  attempting 
to  sit  out  of  bed  in  a  dressing-gown.  Again,  you 
should  be  able  to  sit  out  of  bed  during  one-hour 
intervals  for  some  days  before  you  attempt  to  dress 
yourself.  Washing  and  dressing  involve  very 
considerable  exercise  and  the  man  who  attempts 
it,  after  being  confined  to  bed  for  some  time,  should 
always  follow  it  with  a  lie-down  before  going  for- 
ward to  other  exercise. 

Walking  should  be  regular  as  to  distance  and 
time  and  should  be  regulated  by  ordinary  common 
sense.  For  example,  to  start  off  walking  down 
hill  would  mean  that  you  would  have  to  climb  the 
hill  toward  the  end  of  your  exercise  when  you 


SPECIAL  WEAPONS  183 

might  be  more  or  less  weary.  It  is  wiser  to  avoid 
hills  until  you  are  able  to  walk  a  mile.  It  need 
hardly  be  stated  that  all  exercise  should  be  taken 
out-of-doors.  Increases  in  the  distance  should 
not  be  made  oftener  than  once  a  week,  and  a 
little  rain  need  not  interfere  with  the  walk  being 
regularly  carried  out.  If  you  are  ever  caught 
in  a  storm,  a  change  of  clothes  and  an  alcohol  rub 
immediately  after  ceasing  to  exercise  will  probably 
prevent  ill  consequences.  You  must  try  to  develop 
a  subconscious  discipline  over  yourself  which  will 
always  control  such  natural  impulses  as  to  crank 
an  automobile,  to  boost  Tommy  into  a  tree,  or  to 
force  a  window  which  is  tantalizingly  stubborn. 
Never  attempt  any  pulmonary  gymnastics,  such  as 
blowing  water  from  one  bottle  to  another,  without 
the  advice  of  your  doctor. 

If  rest  be  important  after  a  dose  of  tuberculin, 
it  is  just  as  important  after  the  self -inoculation 
with  tuberculin  which  occurs  during  exercise.  If 
it  be  important  that  an  overdose  of  tuberculin 
-should  not  be  administered,  it  is  just  as  imperative 
that  you  should  not  give  yourself  an  overdose  of 
your  own  tuberculin  by  exercising  too  freely. 
Further,  if  tuberculin  should  be  given  in  uniformly 
gradually  ascending  doses,  likewise  exercise  should 
be  taken  uniformly,  regularly,  and  methodically. 
To  be  capricious  or  impulsive  about  your  exercise 
is  liable  to  be  just  as  dangerous  as  if  a  doctor,  just 
because  he  felt  like  it, were  to  give  you  many  times 
as  much  tuberculin  as  was  wise. 

When  you  are  taking  a  course  in  tuberculin,  do 
not  be  too  ready  to  blame  the  doctor  if  the  inocu- 


I84  THE  BATTLE  WITH  TUBERCULOSIS 

lation  is  followed  by  a  marked  reaction.  You  may 
be  sure  that  the  doctor's  regulation  of  the  dose  has 
been  more  carefully  considered  than  your  own 
regulation  of  exercise.  Search  your  memory  and 
see  if  you  do  not  find  an  indiscretion  four  or  five 
days  previous  which,  by  coincidence,  is  giving  a 
reaction,  just  at  a  time  when  you  are  especially 
wide  awake  to  symptoms  of  any  kind. 

It  very  often  happens  that  the  greater  part  of 
your  indisposition  is  due  not  so  much  to  the  activ- 
ities of  the  tubercle  bacillus  as  to  a  failure  on  the 
part  of  the  white  cells  and  their  allies  to  hold  in 
check  certain  other  enemy  germs  which  have  come 
to  the  aid  of  the  tubercle  bacilli,  and  comprise  what 
has  already  been  referred  to  as  "  a  mixed  infec- 
tion.'* To  increase  the  fighting  strength  of  the 
white  cells  and  their  allies  against  such  mixed  in- 
fections, a  vaccine  is  often  used.  There  are  two 
groups  of  vaccines — stock  and  autogenous  vaccines. 
The  former  are  generally  kept  in  stock  by  drug- 
gists and  are  valuable  in  combating  certain  acute 
infections  which  do  not  give  time  for  the  prepara- 
tion of  an  autogenous  vaccine.  In  mixed  infec- 
tions of  the  lungs,  however,  it  is  generally  advan- 
tageous to  have  a  vaccine  prepared  from  the  par- 
ticular strain  of  germ  which  is  attacking  the  patient. 
To  prepare  such,  the  germs  are  taken  from  the 
patient's  sputum  and  such  as  it  is  desired  to  use 
are  carefully  separated  out,  grown  in  pure  cultures 
and  finally  made  into  an  autogenous  vaccine.  The 
bodies  of  the  germs  in  an  autogenous  vaccine  will 
more  than  likely  whet  the  appetites  of  the  white 


SPECIAL  WEAPONS  185 

cells  for  the  particular  brand  of  enemy  that  is 
causing  the  mischief. 

About  one  patient  in  twelve,  treated  with  vac- 
cine for  mixed  lung  infection,  shows  truly  mar- 
vellous improvement,  and  for  this  reason  there  is 
perhaps  a  good  excuse  if  vaccines  are  given  just  a 
little  too  frequently.  It  is  a  mistake  to  suppose  that 
the  selection  of  patients  for  vaccine  treatment  is 
not  to  be  very  carefully  made,  or  that  a  vaccine  is 
incapable  of  doing  harm.  Undoubtedly,  at  times,  a 
vaccine  so  irritates  the  diseased  area  that  without 
it  the  patient  would  have  made  better  progress. 
Only  an  expert  can  advise  you  wisely  as  to  whether 
or  not  you  should  submit  to  vaccine  treatment.  Do 
not  attempt  to  decide  this  for  yourself. 

In  addition  to  tuberculin  and  vaccine,  a  third 
special  weapon,  in  the  battle  against  the  tubercle 
enemy,  is  what  is  known  as  "  artificial  pneumo- 
thorax." This  has  for  its  object  the  splinting  of 
the  lung  on  one  side  so  that  it  will  be  at  perfect 
rest  until  its  diseased  areas  have  had  an  opportunity 
to  heal.  Imagine  the  neck  of  a  football  bladder  so 
arranged  that  the  air  could  escape  through  it  just 
as  air  can  escape  through  the  bronchial  tube  from 
the  lung  when  pressure  Is  brought  to  bear  on  it. 
Imagine  also  the  operation  of  inserting  a  tubular 
needle  through  the  leather  cover  of  the  football, 
but  not  Into  the  rubber  bladder,  and  of  forcing  gas 
In  through  the  needle  so  as  gradually  to  compress 
and  collapse  the  bladder,  and  you  have  a  mental  pic- 
ture of  what  actually  takes  place  in  artificial  pneu- 
mothorax. The  bladder  represents  the  lung,  the 
leather  cover  the  chest  wall,  and  the  space  between. 


I86  THE  BATTLE  WITH  TUBERCULOSIS 

the  pleural  cavity.  By  inserting  a  tubular  needle 
through  the  chest  wall  and  carefully  injecting  gas 
into  the  pleural  cavity,  the  lung  of  one  side  becomes 
pressed  upon  and  collapsed,  so  that  it  is  put  out  of 
commission  and  is  at  rest.  The  gas  is  gradually 
absorbed,  so  that  treatments  of  gas  injection  must 
be  kept  up  at  longer  or  shorter  intervals  for  months ; 
and  after  healing  has  taken  place  the  lung  may 
gradually  return  to  its  old  position. 

Special  weapons  in  tuberculosis  are  all  two- 
edged,  and  are  as  capable  of  cutting  in  the  wrong 
direction  as  in  the  right  one.  Only  those  who  are 
experienced  should  attempt  to  wield  them,  and 
they  should  never  be  brought  into  play  if  good 
progress  can  be  made  without  them.  They  are  in 
no  sense  a  substitute  for  rest,  and  must  never  be 
a  balm  for  impatience.  The  longest  way  round,  in 
a  faithfully  followed  rest  treatment,  is  often  the 
shortest  way  to  the  desired  goal. 


CHAPTER  XXI 
The  Course  of  the  Battle 

As  the  battle  runs  its  course,  three  outstanding 
conditions  occasion  considerable  attention :  weight, 
cough,  and  temperature.  To  the  uninformed  in- 
dividual, weight  is  of  paramount  importance.  So 
long  as  a  tuberculous  patient  is  fat  and  looks  well, 
there  is,  he  thinks,  not  much  to  worry  about.  Un- 
doubtedly it  is  a  disadvantage  to  be  very  thin,  but 
there  is  not  always  the  advantage  there  appears  to 
be  in  carrying  good  weight.  The  majority  of  pa- 
tients who  are  not  very  ill  will  put  on  fat  very 
quickly,  even  as  much  as  thirty  pounds  in  a  month, 
when  first  they  follow  the  rest  treatment.  Until 
the  germ  enemy  is  imprisoned,  however,  should 
they  return  to  work,  they  will  lose  the  fat  just  as 
quickly  as  they  gained  it.  Sustained  good  weight 
in  combination  with  the  ability  to  continually  carry 
out  strenuous  exercise  is  a  physical  asset  of  great 
value,  but,  while  it  is  always  an  advantage  to  be 
fairly  fat,  the  tuberculous  invalid  must  not  indulge  a 
false  optimism  concerning  the  soft  obesity  of  in- 
valid days. 

Until  such  time  as  the  toxin  of  the  tubercle 
bacillus  is  prevented  from  entering  the  blood,  you 
cannot  expect  to  hold  your  weight  when  exer- 
cising, because  the  poison  lessens  the  ability  of 
the  body  cells  to  take  in  nutrition.  Also,  with- 
out exercise,  your  legs  are  sure  to  become  lament- 

187 


I88  THE  BATTLE  WITH  TUBERCULOSIS 

ably  small  and  flabby,  but  this  is  a  lesser  evil  than 
losing  everything  through  endeavoring  to  keep  in 
training.  After  all,  it  takes  but  a  month  or  two 
for  the  legs  to  regain  their  original  proportions 
after  the  lung  is  healed  and  the  poison  in  conse- 
quence shut  off.  As  a  rule,  tuberculous  patients 
gain  a  little  in  weight  from  August  to  December, 
remain  more  or  less  stationary  from  December  to 
March  and  fall  off  slightly  from  March  to  August. 
A  gain  in  weight  generally  shows  itself  first  in  the 
face  and  chest. 

If  weight  is  a  deceptive  factor  in  tuberculosis,  so 
also  is  cough.  It  is  not  the  patient  who  coughs  the 
most  or  the  loudest  who  necessarily  has  the  most 
trouble.  Generally,  the  old-time  tuberculous  patient 
has  learned  how  to  control  his  cough  and  manages 
to  bring  up  his  sputum  with  very  little  effort. 
Every  patient  should  from  the  beginning  practise 
controlling  his  cough.  Not  until  he  has  had  an  at- 
tack of  pleurisy,  however,  will  he  find  out  how  com- 
pletely it  is  possible  to  control  it.  Coughing  is 
strenuous  exercise  for  the  lungs,  and  unless  it  is 
productive,  i.e.,  unless  it  brings  up  sputum,  is  worse 
than  useless. 

You  will  remember  that  the  air-passages  are 
lined  with  forests  of  ciHa  (described  in  Chapter 
III)  and  that  the  function  of  the  cilia  is  to  propel, 
out  of  the  air-passage  up  to  the  throat,  dust, 
mucus,  pus,  etc.,  which  comprise  sputum.  When  the 
sputum  reaches  a  certain  sensitive  spot  in  the  air- 
passages  it  begins  to  tickle  and  irritate,  and,  if  the 
passage  is  inflamed,  i.e.,  if  bronchitis  exists,  cough 
inevitably  takes  place  sooner  and  more  forcibly 


THE  COURSE  OF  THE  BATTLE      189 

than  is  necessary.  When  sputum  and  irritating 
particles  are  in  the  air-passages,  they  should  be  ex- 
pelled, and  cough  is  a  most  valuable  means  for  ac- 
complishing this,  but  the  point  is  that  the  cilia  must 
be  allowed  to  do  their  work  to  the  full,  and  cough 
be  employed,  not  to  pump  up  sputum  when  it  is 
deep  down  in  the  chest,  but  only  after  the  cilia  have 
propelled  it  well  up  towards  the  throat.  To  lock 
up  sputum  by  preventing  cough  with  medicines  is, 
except  under  exceptional  circumstances,  such  as 
during  a  hemorrhage,  the  height  of  folly.  When 
cough  is  persistent,  it  is  an  indication  to  avoid 
exertion,  even  talking  and  laughing,  to  say  noth- 
ing of  singing. 

One  must  also  be  careful  to  avoid  smoke,  dust, 
sudden  changes  in  temperature,  exposure  of  the 
surface  of  the  body,  and  the  suggestion  to  cough 
which  naturally  comes  from  hearing  other  people 
do  the  same  thing.  A  sip  of  cold  water,  a  small 
piece  of  ice,  a  little  orange  juice,  or  even  a  licorice 
lozenge  is  sometimes  helpful,  but  the  lozenges  must 
be  limited  in  number.  The  morning  cough  is  often 
helped  with  a  glass  of  hot  water  or  milk  containing 
a  pinch  of  salt,  and  the  night  cough,  i.e.,  the  cough 
which  occurs  on  lying  down,  may  be  moderated  by 
similar  treatment  one-half  hour  before  going  to 
bed.  It  is  most  important  also  that  the  bed  should 
be  warm  before  getting  into  it.  Cough  is  very 
liable  to  occur  on  change  of  position,  and  it  is  im- 
portant to  make  a  point  of  assuming  at  regular 
intervals  during  the  day  the  position  that  brings  up 
the  sputum  so  as  to  keep  the  chest  cleaned  out.  Ex- 
ercise also,  when  it  is  indicated,  is  most  helpful  in 


I90  THE  BATTLE  WITH  TUBERCULOSIS 

eliminating  sputum.  Where  coughing  causes 
gagging  or  vomiting,  as  it  often  does  in  a  bed 
patient  when  he  sits  up  in  bed  for  breakfast,  it  is 
just  as  well  for  him  to  sit  up  half  an  hour  before 
meals  and  have  a  clean-out  so  that  the  meals  will 
in  no  way  be  interfered  with. 

Temperature,  while  affording  a  more  reliable 
indication  of  the  course  of  the  battle  than  weight 
or  cough,  is  nevertheless  quite  frequently  deceptive 
in  a  negative  way.  You  may  rely  on  it  being  a  sure 
indication  of  adverse  conditions  when  it  is  elevated, 
but  it  is  possible,  on  the  other  hand,  for  the  battle 
to  swing  the  wrong  way  without  the  temperature 
showing  the  naturally  expected  fluctuations.  Very 
often  the  quickening  of  the  pulse  affords  an  earlier 
indication  of  trouble  than  temperature  does,  as  the 
pulse  is  more  liable  to  quicken  than  the  temperature 
is  to  rise.  Generally,  however,  the  temperature  is 
a  safe  guide.  Should  it  remain  above  normal,  even 
a  fraction  of  a  degree,  throughout  the  whole  day, 
it  is  an  imperative  command  to  remain  in  bed. 
Should  it  reach  the  ioo°  mark,  it  is  an  indication 
to  go  to  bed  and  refuse  to  see  visitors  until  the 
doctor  has  advised  on  the  matter.  ioi°  demands 
continuous  stay  in  bed.  Where  a  patient  has  gone 
some  time  without  temperature,  even  a  slight  rise 
above  normal  should  mean  rest  in  bed  until  the 
movement  the  enemy  intends  to  make  is  ascertained. 
A  temperature  of  99.5°  or  ov«r  forbids  exercise, 
except  dressing  and  going  to  meals,  and  if  tem- 
perature is  over  99°,  exercise  must  not  be  taken 
without  the  doctor's  permission.  Subnormal  tem- 
perature need  cause  no  worry,  although  if  under 


THE  COURSE  OF  THE,  BATTLE  191 

97°  it  Is  a  contra-indication  to  the  taking  of  a 
cold  bath. 

The  patient  with  tuberculosis  is  constantly  on 
the  verge  of  excitement,  so  that  the  visit  of  the 
doctor  may  increase  the  pulse  20  beats  a  minute. 
If  at  any  time,  while  at  rest  during  the  day,  the 
pulse  reaches  1 10  or  over,  exercise,  even  dressing, 
is  prohibited.  The  transaction  of  business,  dis- 
cussions, card  games,  and  letter-writing  will,  in  the 
case  of  many  patients,  cause  a  considerable  rise  in 
temperature.  Likewise  constipation  or  diarrhoea, 
cold  in  the  head,  or  sore  throat,  Is  an  occasional  ex- 
citing cause.  But  the  most  frequent  promoter  of 
elevated  temperature  is  over-exercise.  Exercise  oa 
the  day  it  Is  taken  often  lowers  the  mouth  tempera- 
ture, and  the  real  effects  do  not  appear  for  one,  two, 
or  even  four  or  more  days  afterwards.  If  you  re- 
member nothing  else,  at  least  remember  the  possi- 
bility of  delayed  reaction.  Delayed  reaction  is  the 
submerged  rock  upon  which  many  a  patient  has 
wrecked  his  chances  of  success.  Do  not  imagine 
that  because  you  appear  to  escape  without  bad 
effects  after  over-exercise  you  will  not  pay  up  for 
it  in  the  long  run.  The  tubercle  bacillus  is  slow  In 
reproducing  himself,  and  while  he  may  only  start 
his  developing  operations  on  the  day  the  white  cells 
and  their  allies  have  been  too  fatigued  to  closely 
watch  him,  the  start  he  gains  is  sure  to  be  followed 
by  definite  results  some  time  later. 

In  a  well-known  sanatorium,  a  certain  young 
man  who  enjoyed  the  sobriquet  of  "  Duffy  "  was 
supposed  to  be  "  chasing  the  cure."  Duffy  was  a 
pink-cheeked  boy  with  beautiful,  large,  blue  eyes 


192  THE  BATTLE  WITH  TUBERCULOSIS 

that  looked  out  from  under  long,  dark  lashes.  The 
ladies  thought  him  perfectly  lovely,  and  it  need 
hardly  be  said  that  he  reciprocated  cordially  any 
demonstrations  of  appreciation.  So  long  as  Duffy 
remained  strictly  in  his  own  quarters,  his  good 
progress  continued  without  interruption,  but  the 
time  came,  as  it  is  liable  to  come  to  us  all,  when  he 
had  gained  sufficient  strength  to  go  forth  into  a 
world  that  for  some  of  us  is  awfully  full  of  tempta- 
tion. The  first  occasion  was  a  little  Hallowe'en  en- 
tertainment, and,  the  morning  after,  Duffy  confided 
to  a  friend  with  some  gusto  (  Duffy's  greatest  ambi- 
tion was  to  be  "  a  good  sport ")  that  he  had  found 
the  entertainment  too  slow  to  suit  him,  and  so  had 
wandered  forth  into  the  moonlight  with  a  certain 
very  lovely  young  lady  for  a  distance  of  half  a  mile 
or  so.  Up  to  this  time,  dressing  himself  had  been 
Duffj^'s  limit  of  exercise,  but  as  he  said  he  felt 
fine  the  next  day  he  guessed  it  had  not  done 
him  any  harm.  Four  days  later  Duffy  went  to  bed 
with  a  hemorrhage. 

By  the  time  the  next  sanatorium  concert  came 
along,  Duffy  was  once  more  up  and  around,  and  se- 
cured permission  to  go  to  the  concert.  But,  as  he 
jubilantly  related  the  following  morning,  on  his  way 
home  some  of  the  girls  corralled  him  and  some- 
thing like  a  wrestling  match  took  place.  However, 
he  guessed  it  hadn't  done  him  any  harm,  because  he 
was  feeling  fine.  Four  days  later,  when  he  had 
forgotten  all  about  the  folly,  Duffy  had  another 
hemorrhage. 

A  month  or  two  elapsed  before  a  further  indis- 
cretion took  place;  as  usual  it  was  related  with 


THE  COURSE  OF  THE  BATTLE       I93 

gusto,  and,  as  usual,  was  followed  four  days  later 
by  a  hemorrhage.  The  third  hemorrhage  had 
not  been  recovered  from  very  long  when  one  day 
Duffy  was  discovered  in  the  diet  kitchen  indulging 
in  a  little  horse-play  with  one  of  the  nurses.  Four 
days  later  he  went  to  bed  with  a  hemorrhage,  and 
for  over  a  month  he  continued  day  after  day  to 
cough  up  blood,  and  several  months  elapsed  before 
he  was  again  able  to  be  out  of  bed. 

Four  days  was  apparently  Duffy^s  period  of  de- 
layed reaction,  but  many  patients  have  gone  as  long 
as  a  month  before  paying  the  inevitable  price  of 
bygone  and  forgotten  indiscretions. 

Elevated  temperature  is  often  accompanied  or 
followed  by  sweats,  which  usually  occur  during 
sleep.  They  vary  in  severity  from  a  scarcely  per- 
ceptible perspiration  to  a  drenching  sweat  that 
soaks  not  only  night  robes  but  bedclothes  as  well. 
When  a  patient  shows  an  inclination  to  perspire 
during  sleep,  cotton  bedclothes  should  give  place 
to  flannelette  or  outing-flannel  sheets,  and  the  night 
robes  should  be  woollen.  Too  heavy  a  covering 
should  be  avoided,  especially  over  the  feet.  If 
the  sweat  appears  to  be  due  to  weakness,  it  is  well 
to  give  some  nourishment  during  the  night.  An. 
alcohol  rub  or  vinegar  sponge  at  bedtime  Is  often 
helpful  as  a  preventive,  as  is  also  an  ice-bag  on  the 
abdomen  for  several  hours  during  the  evening.  If 
the  sweat  be  considerable,  i.e.,  enough  to  wet  the 
undergarments,  a  change  of  clothing  is  Indicated, 
and  care  must  be  taken  not  to  expose  the  body 
more  than  is  necessary.  When  effecting  the 
13 


I94  THE  BATTLE  WITH  TUBERCULOSIS 

change,  a  brisk  rub  with  a  Turkish  towel  is  com- 
forting. 

Chills  are  better  avoided  than  cured.  Avoid  ex- 
posure of  the  body,  and  do  not  drink  cold  fluids, 
or  eat  iced  foods,  on  a  cold  day.  In  high  altitudes 
it  must  be  remembered  that  the  change  of  tempera- 
ture is  liable  to  be  sudden,  and  necessary  wraps 
should  always  be  at  hand.  Hot-water  bottles,  hot 
drinks,  and  plenty  of  blankets,  are  indicated  should 
a  chill  supervene. 

The  course  of  the  battle  is  seldom  continuously 
favorable  or  continuously  unfavorable.  It  may  be 
compared  to  the  waves  of  the  ocean:  first,  long 
rollers,  broken  by  small  waves,  and  then  the  small 
waves  lined  with  wavelets.  The  wavelets  represent 
the  individual  days  in  the  course  of  the  battle,  one 
day  up  a  little  and  the  next  day  down  a  little ;  the 
waves  represent  ten-  to  twenty-day  periods,  one 
period  favorable  or  positive,  and  the  next  unfavor- 
able or  negative;  but  it  is  the  long  rollers  that 
picture  the  real  course  of  the  battle,  the  course  as 
you  would  see  it  could  you  stand  afar  off  detached 
from  yourself,  and  gain  the  perspective  that  the 
general  gains  as  he  views  the  course  of  a  battle 
through  his  field  glasses.  Too  many  patients,  like 
men  in  the  trenches,  judge  the  course  of  the  battle 
by  the  exigencies  of  the  moment,  and  lose  sight  of 
the  fact  that  there  are  bound  to  be  reverses  and, 
what  is  equally  dangerous,  that  there  are  bound  to 
be  deceptively  calm  days.  And  so  patients  often 
become  the  victims  of  symptoms,  depressed  and  dis- 
couraged one  week  because  temperature  is  elevated, 
elated  into  folly  the  next  week  because  there  is  an 


THE  COURSE  OF  THE  BATTLE  195 

absence  of  unfavorable  signs;  they  float  along  like 
a  boat  without  a  rudder,  tossed  by  every  wave,  and 
they  never  arrive  anywhere.  The  following  is  a 
familiar  case : 

A  patient  has  been  lying  very  quiet  for  a  week 
or  two,  with  a  temperature  that  reaches  99.5° 
every  day;  the  doctor  has  advised  that  this  is  the 
right  course  to  follow,  but  the  patient  finds  the 
temperature  does  not  come  down  quite  as  quickly 
as  he  had  anticipated.  One  day  there  happens  in  a 
friend  who  tells  him  that  he  suffered  in  just  the 
same  way  until  he  got  up  and  took  exercise.  Ac- 
cordingly, patient  No.  i  rises  and  walks  forth,  with 
the  result  that  temperature  vanishes.  Naturally 
he  is  quite  convinced  that  the  doctor  did  not  know 
what  he  was  talking  about.  But  four  or  five  days 
later  he  discovers  that  without  any  rhyme  or 
reason  his  temperature  is  100°,  and,  of  course,  he 
is  utterly  discouraged  and  really  is  quite  at  a  loss 
to  know  what  to  do.  Do  you  wonder  that  the  doc- 
tor sometimes  nearly  weeps  or  feels  inclined  to  let 
a  patient  suffer  the  consequences  of  his  own  igno- 
rance and  folly ! 

You  must  realize  that  the  symptoms  of  any  one 
day  are  usually  too  insignificant  an  indication  to 
effect  any  considerable  change  in  your  course  of 
action.  The  battle  must  be  viewed  from  a  distance, 
and  action  for  a  definite  period  must  be  shaped 
upon  an  intelligent  survey  of  collective  conditions. 
If  your  temperature  has  been  showing  a  tendency  to 
rise  above  a  certain  point,  a  consultation  with  your 
doctor  is  indicated.  He  will  map  out  a  course  to 
follow  for  the  next  month,  and  even  if  the  tem- 


196  THE  BATTLE  WITH  TUBERCULOSIS 

perature  seems  to  vanish  the  very  next  day,  that 
course  should  be  carried  out  definitely.  If  ever 
you  are  in  doubt  whether  to  rest  or  exercise,  g^ve 
to  rest  the  benefit  of  the  doubt. 

If  you  would  arrive  at  victory,  you  must  not  be 
a  victim  of  symptoms,  you  must  realize  that  you 
have  a  term  of  service  to  put  in,  just  as  much  as 
the  soldier  in  the  trenches.  That  term  of  service 
will  be  punctuated  with  one  series  of  reverses  and 
gains,  but  the  course  must  not  be  altered  on  account 
of  either.  It  must  be  mapped  out  month  by  month 
in  consultation  with  your  medical  adviser,  and  fol- 
lowed to  the  letter,  one  day  at  a  time,  and  every 
hour  of  every  da,y  must  be  made  to  count. 


CHAPTER  XXII 
The  Tactics  of  the  Enemy 

Were  the  tubercle  bacillus  left  entirely  to  his 
own  resources  in  his  attack  on  the  white  cells  and 
their  allies,  in  the  majority  of  cases  he  would  meet 
with  ignoble  defeat.  However,  he  is  endowed  with 
untiring  patience,  and  he  seems  to  be  willing  to  bide 
his  time  for  years,  if  need  be,  until  some  germs  of 
another  division  come  to  his  aid ;  that  is,  until  there 
occurs  a  secondary  infection.  The  supporting 
columns  of  the  tubercle  bacillus  most  frequently 
gain  admittance  to  the  body  at  the  time  you  "  catch 
cold."  "What  a  multitude  of  sins  are  covered  by 
that  innocent  expression !  The  man  with  tubercu- 
losis may  catch  cold  and  recover  from  it  just  as 
other  people  do,  but  with  him  such  a  complication  is 
liable  to  prove  more  than  an  episode.  It  quite 
possibly  becomes  an  event  in  the  history  of  his 
disease.  So-called  catching  cold  must  therefore  be 
guarded  against  with  the  greatest  care. 

We  have  seen  that  germs  around  a  decayed 
tooth,  or  in  the  crypt  of  a  diseased  tonsil,  comprise 
a  sort  of  reception  committee  to  other  germs  which 
enter  the  mouth  by  chance.  The  presence  of  one 
division  of  germs  and  of  decaying  matter,  stimu- 
lates the  growth  of  other  divisions.  Hence  the 
tuberculous  patient  must  see  to  it  that  his  teeth  are 
kept  in  a  perfectly  health\y  condition,  that  his 
tonsils  are  free  from  disease,  and  that  his  nose 
does    not   afford    a   favorable   environment    for 

197 


198  THE  BATTLE  WITH  TUBERCULOSIS 

catarrhal  or  other  disease-producing  germs.  He 
should  be  able  to  breathe  freely  through  his  nose, 
because,  as  has  been  mentioned,  the  normal  nose 
arrests  95  per  cent,  of  the  dust  and  germs  in  the  air 
that  enter  it,  while  the  mouth  is  not  specially 
equipped  for  respiratory  purposes. 

It  is  important  to  avoid  localities  from  which, 
and  people  from  whom,  secondary  infections  may 
be  contracted.  Street-cars,  theatres,  picture-shows, 
shops,  and  even  the  city  streets,  afford  more  or 
less  chance  of  infection.  Likewise  people  with 
colds,  and  children  with  running  noses,  should  be 
avoided,  and  during  epidemics  of  so-called 
"  grippe "  the  tuberculous  patient  should  stay 
strictly  at  home.  Amusements  which  give  rise  to  a 
dusty  environment,  as,  for  example,  dancing,  in- 
door-bowling, and  the  like,  should  not  be  attended, 
let  alone  participated  in.  Likewise,  games  which 
cause  overheating  are  risky.  If  a  musician,  it  is 
best  not  to  indulge  your  talent  without  special  per- 
mission. 

Perhaps  the  greatest  protection  against  taking 
cold  is  constant  living  out-of-doors.  To  the  person 
who  sleeps  out-of-doors,  and  spends  from  eight  to 
ten  hours  outside  during  the  day,  as  nearly  every 
tuberculous  individual  ought  to  do,  even  in  the 
heart  of  winter,  a  cold  occurs  about  as  rarely  as 
measles.  The  patient  should  avoid  lying,  sitting, 
or  walking  in  a  strong-  wind.  Sensible  perspiration 
or  chilliness  is  equally  dangerous,  and  an  under- 
shirt damp  with  perspiration  should  always  be 
changed  without  delay.  As  the  winter  gives  way 
to  warmer  weather,  stick  to  your  flannels  until  they 


THE  TACTICS  OF  THE  ENEMY  199 

Stick  to  you.  They  may  be  worn  much  further  into 
the  warm  weather  by  the  patient  who  is  taking  the 
rest  cure  than  by  others.  When  it  can  be  afforded, 
underwear  of  intermediate  weight  is  of  advantage 
for  use  in  spring  and  fall. 

Careful  attention  to  the  skin  is  another  important 
factor  in  the  prevention  of  colds.  The  morning 
cold  plunge  or  sponge,  followed  by  a  rub,  sufficiently 
brisk  to  cause  a  skin  reaction,  i.e.,  a  rosy  glow  on 
the  skin,  is  most  valuable.  Many  patients  in  be- 
ginning this  treatment  do  well  to  start  with  hot 
water,  followed  immediately  by  cold  and  exposing 
but  a  small  portion  of  the  body  at  one  time.  From 
day  to  day  the  temperature  of  the  hot  water  should 
be  lowered  until  it  can  be  dispensed  with,  thereby 
avoiding  the  shock  that  usually  attends  one's  initia- 
tion to  cold-water  baths.  Where  fatigue,  chilliness, 
blueness  of  the  skin  or  lips,  or  failure  of  the  skin 
to  react  follows  the  taking  of  a  bath,  it  should  not 
be  persisted  in.  On  the  other  hand,  a  warm  glow 
and  a  feeling  of  well-being  is  an  indication  that  the 
cold  bath  is  of  advantage. 

The  most  frequent  result  of  so-called  "  catching 
cold  "  in  the  case  of  a  tuberculous  patient  is  a  little 
localized  congestion,  either  near  the  diseased  area 
of  the  lung,  or  in  the  pleura.  It  is  best  treated  in 
the  good  old-fashioned  way  of  applying  a  mustard 
plaster.  Simply  a  hot-water  bag  often  effects  a 
cure.  Painting  the  area  with  tincture  of  iodine  is 
most  helpful  to  some.  It  is  well  to  apply  the  iodine 
in  little  circles  or  squares  like  a  checker-board,  so 
that  the  second  application  may  go  on  unpainted 
skin  and  thus,  as  far  as  possible,  save  the  skin  from 


200  THE  BATTLE  WITH  TUBERCULOSIS 

the  soreness  which  follows  several  applications. 
Where  the  pain  from  pleurisy  is  very  great,  a 
binder  pinned  around  the  chest  as  tightly  as  possible 
limits  the  movement  and  thus  alleviates  the  pain. 

Tuberculous  laryngitis,  while  it  may  be  promoted 
by  an  ordinary  cold,  is  not  caused  by  it.  Anything 
which  inflames  a  throat  and  larynx,  such  as  shout- 
ing, singing,  smoking,  sand  or  dust  storms,  and  the 
like,  is  liable  to  cause  minute  cracks  in  the  mem- 
brane which  covers  the  vocal  cords,  and  these 
cracks  may  afford  to  the  tubercle  bacillus  a  location 
in  which  to  establish  his  camp.  Once  the  enemy 
has  formed  his  tubercle,  the  cords  become  in- 
flamed and  are  liable  more  than  ever  to  develop 
minute  cracks  in  which  the  disease  may  advance. 
Consequently  the  patient  with  tuberculosis  of  the 
▼ocal  cords  should  whisper  instead  of  talk  out 
loud,  because  the  latter  causes  vibration  of  the 
cords,  and  when  the  inflamed  cords  vibrate  they 
are  more  liable  to  develop  cracks.  When  hoarse- 
ness exists  in  the  throat  from  any  cause,  it  is  a  sign 
that  the  cords  are  inflamed,  and,  then  also,  it  iS 
most  important  to  refrain  from  talking  out  loud. 
Simple  inflammation  with  accompanying  hoarse- 
ness 13  often  relieved  by  increasing  the  moisture  in 
the  room  with  steam. 

When  advised  by  your  physician  to  whisper  on 
account  of  trouble  in  your  larynx,  it  is  utter  folly 
not  to  obey  his  advice  on  account  of  the  comment 
that  is  liable  to  be  made.  What  does  it  matter  if 
people  foolishly  suppose  you  are  too  weak  to  talk 
out  loud,  or  your  fellow-patients  learn  that  you  have 
a  tuberculous  tliroat !    Think  of  the  years  to  come 


THE  TACTICS  OF  THE  ENEMY  201 

when  the  foolish  people  will  have  forgotten  that 
you  ever  had  throat  trouble,  and  the  majority  of 
your  fellow  patients  will  be  in  their  graves.  It  will 
matter  little  then  what  people  thought  or  said,  but 
It  will  matter  a  great  deal  whether  or  not,  when 
your  throat  was  invaded,  you  whispered  or  talked 
out  loud. 

What  is  the  truth  about  smoking  ?  Does  it  really 
do  any  harm  ?  That  depends  more  on  the  patient 
than  on  the  tobacco.  Some  men  who  have  smoked 
for  years  are  impervious  to  the  effects  of  nicotine, 
others  are  kept  under  weight  by  it  because  nicotine 
generally  prevents  the  body  cells  from  properly 
absorbing  nutrition.  Men  of  nervous  tempera- 
ments have  their  hearts  made  irritable,  their  pulse- 
beats  quickened  by  from  ten  to  twenty  beats  a 
minute,  and  their  whole  nervous  mechanism  de- 
pressed by  the  toxin.  Every  man  who  smokes 
absorbs  a  certain  amount  of  toxin  through  the 
mucous  membrane  of  the  mouth,  pharynx  and 
stomach.  Inhaling  tobacco  smoke  is  always 
fraught  with  evil  consequences,  and  excessive 
spitting  is  liable  to  deprive  the  food  of  some  of 
the  necessary  juices.  Consequently,  the  man  with 
tuberculosis  who  smokes  is  taking  a  chance. 
Should  he  have  any  inflammatory  condition  of  the 
throat,  smoking  should  be  absolutely  prohibited, 
and  so  long  as  his  disease  is  active,  his  cough  irri- 
table, or  his  weight  reduced,  he  would  be  much 
wiser  to  leave  tobacco  alone.  In  any  event  he 
should  place  a  limit  on  the  number  of  pipes,  cigars, 
or  cigarettes  he  allows  himself  in  any  one  day,  and 
that  limit  should  be  rigidly  adhered  to. 


3Q2  THE  BATTLE  WITH  TUBERCXn^OSIS 

Probably  the  most  alarming  accident  during  the 
course  of  the  battle  is  a  hemorrhage.  It  often 
seems  to  come  out  of  a  clear  sky,  and  may  occur 
at  practically  any  time  during  the  course  of  the 
disease.  Oftener  it  is  the  result  of  some  indiscre- 
tion, an3  unfortunately  it  does  not  always  show 
itself  at  the  time,  but  is  liable  to  occur  some  hours 
or  days  later.  It  may  range  in  quantity  from  just 
a  coloring  of  the  sputum  to  one  or  two  pints  of 
blood.  Very  often  a  little  coloring  of  the  sputum 
precedes  the  hemorrhage,  which  may  come  some 
hours  later,  so  that  "color  "  must  be  treated  seri- 
ously. The  nervous  patient  is  constantly  finding 
color  that  alarms  everybody  until  it  is  discovered 
that  it  made  its  appearance  when  he  was  cleaning 
his  teeth,  or  after  he  had  had  a  slight  nose-bleed. 

Color  is  most  liable  to  api)ear  early  in  the  morn- 
ing, when  you  are  coughing  just  after  awakening. 
It  is  generally  intimately  mixed  in  with  the  sputum. 
If  it  appears  to  be  distinct  and  separate  from  clear 
sputum,  as  is  a  little  clot  or  streak,  quite  possibly 
it  comes  from  the  back  of  the  nose.  To  make  sure, 
cleanse  the  mouth  and  throat  carefully  by  gargling 
with  one-half  a  teaspoonful  of  baking  soda  in  one- 
third  of  a  tumbler  of  warm  water,  and  watch  the 
next  lot  of  sputum  coughed  up.  If  it  be  colored 
with  blood,  it  is  well  to  go  quietly  to  bed,  take  a  lax- 
ative, such  as  a  dose  of  Epsom  salts,  and  refrain 
from  eating  or  drinking  anything  until  the  doctor 
has  advised  fully  on  the  matter. 

Although  you  will  quite  probably  run  the  course 
of  your  disease  without  the  accident  of  a  hemor- 
rhage, it  is  nevertheless  important  that  you  should 


THE  TACTICS  OF  THE  ENEMY  203 

consider  just  what  your  actions  would  be  in  the 
event  of  such  an  emergency.  The  treatment  for 
hemorrhage  from  the  lung  has  two  important  ob- 
jects in  view:  (i)  To  limit  the  loss  of  blood  as 
much  as  possible,  and  (2)  to  prevent  blood  being 
aspirated  or  sucked  into  the  air-spaces  of  the  lung. 
Such,  a  complication  when  extensive  is  liable  to 
cause  "  post-hemorrhagic  pneumonia/'  i.e.,  pneu- 
monia following  the  hemorrhage.  Should  you  be- 
come excited  when  the  hemorrhage  occurs,  and 
start  to  run,  or  struggle,  or  endeavor  to  hold  back 
the  blood,  both  of  these  objects,  in  all  probability, 
will  be  defeated.  It  is  obvious  that  such  conduct 
will  not  only  make  the  heart  pump  the  blood  more 
quickly  out  of  the  ruptured  vessel  in  your  lung,  but 
it  will  also  cause  blood  to  be  sucked  into  large  areas 
of  the  lung. 

Should  a  hemorrhage  occur,  your  line  of  action 
should  be  to  sit  down  aaid  keep  quiet.  Should 
you  be  in  a  shop,  sit  down;  should  you  be  on  the 
street,  sit  down — it  is  no  time  to  look  for  a  chair — ■ 
sit  down  in  the  middle  of  the  road  if  necessary. 
Of  course,  it  will  cause  commotion  and  talk,  but 
commotion  and  talk  last  only  nine  days,  and  life 
is  worth  more  than  that.  Control  the  coughing 
as  far  as  possible,  do  not  try  to  talk,  and  do  not 
try  to  hold  back  the  blood.  Some  kindly  disposed 
people  will  doubtless  carry  you  home  on  a  chair  or 
in  a  conveyance,  but  if  there  be  no  one  at  hand, 
remain  right  where  you  are  until  the  hemorrhage 
ceases,  or  help  comes.  Once  at  home,  lie  upon  the 
bed  until  the  doctor  comes.  In  the  meantime,  your 
friends  may  remove  any  constrictions  in  your  cloth- 
ing, and  it  would  be  well  for  you  to  take  a  cathartic, 


204  THE  BATTLE  WITH  TUBERCULOSIS 

such  as  a  dose  of  Epsom  salts.  Care  should  be 
taken  not  to  expose  the  skin  to  cold  night-robes 
or  cold  sheets. 

While  the  hemorrhage  is  taking  place,  call  to 
your  mind  the  fact  that,  if  it  were  going  to  be 
fatal,  it  would  probably  have  been  all  over  before 
you  had  had  an  opportunity  to  know  what  had 
happened,  and  that  thousands  of  others  have  had 
hemorrhages  and  lived  to  laugh  at  the  fear  they 
felt.  If  you  can  exercise  enough  self-control  to 
relax  every  muscle  and  lie  limp  on  the  bed,  the 
trouble  will  clear  up  much  more  quickly.  You  will 
Become  very  thirsty,  but  it  is  most  important  that 
you  should  not  drink.  You  will  think  that  your 
back  is  going  to  break,  but  time  is  filled  with  to- 
morrows, and  to-morrow  it  will  not  be  so  bad. 
Other  treatment  which  may  be  necessary  differs  for 
different  patients,  and  therefore  should  be  outlined 
by  your  doctor.  When  a  patient  is  subject  to 
hemorrhages,  it  is  well  for  him  to  carry  in  his 
pocket  an  ampul  containing  five  drops  of  amyl 
nitrite,  and  should  the  hemorrhage  threaten  to  be- 
come excessive,  the  ampul  may  be  broken  into  a 
handkerchief  and  the  fumes  of  the  medicine  in- 
haled. Sometimes  it  is  most  effectual  in  lessening 
the  flow  of  blood,  but  should  be  used  only  in  severe 
cases. 

Indigestion  is  generally  caused  by  overeating, 
fatigue,  irregular  hours,  constipation,  or  impure 
air.  If  you  are  spending  all  night  and  eight  hours 
of  the  day  out-of-doors,  if  you  are  resting  as  much 
as  the  doctor  has  advised,  if  you  are  arising  from 
your  meals  feeling  you  could  eat  a  little  more,  and 
if  your  bowels  are  regular  and  yet  you  are  troubled 


THE  TACTICS  OF  THE  ENEMY  205 

with  indigestion,  you  are  the  one  exception  in  a 
hundred,  and  a  case  for  special  consideration  by 
the  doctor.  Think  it  over  carefully,  however,  and 
be  sure  you  are  carrying  out  your  part  of  the  re- 
quirements before  resorting  to  medicine. 

Intestinal  tuberculosis  is  not  as  frequent  as  an 
occasional  pain  in  the  belly  v^ould  lead  patients  to 
suppose.  Diarrhoea  more  frequently  comes  from 
swallowing  sputum,  or  eating  foods  which  disagree, 
than  from  intestinal  tuberculosis.  Swallowing 
sputum  is  an  exceedingly  dangerous  practice,  and, 
as  mentioned,  no  feelings  of  delicacy  should  ever 
influence  a  patient  to  refrain  from  using  the  sputum 
cup.  When  diarrhoea  and  pain  in  the  abdomen  are 
frequent,  it  is  well  to  wear  a  flannel  or  silk  ab- 
dominal binder.  Cold  drinks  should  be  omitted,  as 
should  also  fruit,  fruit  juices,  most  vegetables, 
sugar,  and  other  sweets.  Fluids  should  also  be 
restricted  in  quantity.  Should  the  pains  be  exces- 
sive, the  ice-bag,  hot-water  bag  or  turpentine  stupes 
applied  to  the  abdomen  may  be  helpful. 

Not  infrequently  a  cold  abscess  makes  its  appear- 
ance near  the  rectum.  This  after  being  opened 
forms  what  is  known  as  "  a  fistula,"  and  may  dis- 
charge for  a  long  time.  It  should  not  cause 
anxiety,  however,  as  if  it  be  kept  properly  cleansed, 
it  may  exist  for  years  without  exerting  any  dis- 
cernible influence  upon  the  general  health. 

Some  patients  are  the  victims  of  insomnia.  It 
is  possible  to  sleep  so  much  during  the  daytime 
or  so  late  into  the  morning  that  one  has  difficulty  in 
getting  to  sleep  or  remaining  asleep  at  night.  Al- 
though it  is  difficult  to  convince  many  patients  of 


206  THE  BATTLE  WITH  TUBERCULOSIS 

the  fact,  it  is  just  as  important  to  wake  up,  or  be 
wakened  up,  at  a  regular  hour  in  the  morning  as  it 
is  to  go  to  bed  at  a  regular  hour  at  night.  Because 
a  man  does  not  sleep  well  at  night  is  no  excuse  for 
allowing  him  to  sleep  in  the  morning.  Such  pro- 
cedure is  promoting  the  difficulty  instead  of  allevi- 
ating it.  The  patient  who  is  troubled  with  in- 
somnia should  have  an  early  light  supper.  He 
should  avoid  all  excitement,  especially  during  the 
evening.  He  should  sleep  in  the  fresh  air,  and  the 
bed  should  be  thoroughly  warmed  before  he  gets 
into  it.  Sometimes  massage  of  the  back  or  an 
alcohol  rub  down  the  spine  is  helpful,  as  is  also  a 
glass  of  hot  milk,  one-half  hour  before  retiring. 

In  Chapter  V  it  was  explained  that  many  a 
patient  with  tuberculosis  has  in  his  chest,  at  the 
time  he  commences  treatment,  a  condition  which 
will  have  to  become  considerably  worse,  so  far  as 
symptoms  are  concerned,  before  a  recovery  can  be 
effected.  It  was  also  pointed  out  that  sometimes, 
as  out  of  a  clear  sky,  a  patient,  when  least  sus- 
pecting trouble,  Is  thrown  on  his  back  apparently 
because  his  condition  has  suddenly  become  very 
serious.  This  is  but  one  of  the  reverses,  and  is 
generally  due  to  an  old-time  diseased  area  of  the 
lung  softening  and  breaking  down  to  be  thrown 
out  of  the  chest.  There  are  many  patients  who  can 
never  be  well  until  after  this  happens,  so  that  it 
should  not  prove  as  discouraging  as  it  appears. 
When  it  comes,  when  any  complication  comes,  it 
is  no  time  to  throw  up  your  hands  and  say  you  want 
to  die.  Many  a  patient  has,  by  sheer  grit  and  per- 
severance, won  His  way  through  one  long  series  of 


THE  TACTICS  OF  THE  ENEMY  207 

tHe  most  trying  conditions  and  complications,  back 
to  victory  and  health.  If  another  patient  can  do  it, 
so  can  you. 

"  You're  sick  of  the  game !"  Well,  now,  that's  a  shame. 

You're  young  and  you're  brave  and  you're  bright. 
"  You've  had  a  raw  deal !"    I  know — but  don't  squeal. 

Buck  up,  do  your  damnedest,  and  fight. 

It's  the  plugging  away  that  will  win  you  the  day, 

So  don't  be  a  piker,  old  pard ! 

Just  draw  on  your  grit ;  it's  so  easy  to  quit : 

It's  the  keeping-your-chin-up  that's  hard. 

It's  easy  to  cry  that  you're  beaten — and  die ; 

It's  easy  to  crawfish  and  crawl; 

But  to  fight  and  to  fight  when  hope's  out  of  sight — 

Why,  that's  the  best  game  of  them  all! 

And  though  you  come  out  of  each  gruelling  bout 

All  broken  and  beaten  and  scarred, 

Just  have  one  more  try — it's  dead  easy  to  die, 

It's  the  keeping-on-living  that's  hard.* 

It  is  when  the  complications  and  serious  re- 
verses come  that  the  patient  who  has  been  bolstered 
up  with  false  hopes  is  liable  to  search  for  short 
cuts  to  a  cure,  and  to  fall  a  victim  to  the  ravages 
of  charlatans  and  patent  medicines.  Philip  P. 
Jacobs,  of  the  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis,  has  investigated 
very  thoroughly  many  so-called  "  consumption 
cures  "  which  are  grasped  at  towards  the  end  of  a 
losing  battle,  as  straws  are  by  a  drowning  man. 
The  summation  of  Dr.  Jacobs's  report  is  that  the 
medicines  investigated  consisted  of  stimulants, 
sedatives,  or  some  absolutely  worthless  substance 
such  as  rye-flour  or  colored  water.  "  Investigation 
of  the  claims  of  hundreds  of  testimonials  for  a 
large  number  of  consumption  cures  has  always 
proved  one  oT  three  things :   ( i )  Either  the  person 

*  "Rhymes  of  a  Rolling  Stone,"  by  Robert  W.  Service, 
page  102. 


2o8  THE  BATTLE  WITH  TUBERCULOSIS 

who  signed  the  testimonial  had  done  so  because  he 
was  paid  for  it;  or  (2)  he  never  had  tuberculosis 
at  all  and  only  imagined  he  had  been  cured ;  or,  most 
frequently,  (3)  that  he  was  very  much  worse,  or 
dead,  as  a  result  of  taking  the  nostrum  at  the  time 
the  investigation  was  made.  .  .  .  An  investiga- 
tion of  the  cases  of  more  than  one  hundred  con- 
sumptives in  a  Western  city,  who  had  been  taking  a 
certain  widely  advertised  consumption  cure,  re- 
vealed the  fact  that  almost  every  one  had  experi- 
enced a  temporary  relief,  but  that  in  every  case  the 
patient  had  either  become  worse,  or  died  in  a  short 
time  afterward." 

If  consumption  cures  always  consisted  of  inert 
substances,  such  as  rye-flour,  the  offence  of  the 
proprietor  would  be  nothing  worse  than  robbery, 
but  unfortunately,  no  matter  what  the  proprietor's 
opinion  on  the  subject,  many  cures  contain  posi- 
tively harmful  drugs,  such,  for  example,  as  potas- 
sium iodide,  which  to  some  patients  means  nothing 
short  of  death.  When  tempted  to  depart  from  the 
narrow  road  of  ethical  treatment,  at  least  remem- 
ber that,  "  The  American  Medical  Association,  535 
Dearborn  Avenue,  Chicago,  will  gladly  tell  you,  if 
you  will  send  them  a  sample,  or  write  to  them 
about  any  so-called  *  cure,'  what  its  real  merits  are. 
It  should  be  worth  a  two-cent  stamp  to  find  out  if 
you  are  taking  poison  or  are  doing  yourself  an 
injury  in  some  other  way."  * 

Apart  altogether  from  patent  medicines,  there 

'For  further  information  on  this  subject,  the  National 
Association  for  the  Study  and  Prevention  of  Tuberculosis 
will,  on  request,  forward  you  a  pamphlet  entitled  "  Fake 
Consumption  Cures,"  which  is  well  worth  reading. 


THE  TACTICS  OF  THE  ENEMY  209 

are  a  few  patients  who,  while  following  the  direc- 
tions of  the  doctor,  make  the  grave  mistake  of 
carrying  out  some  line  of  treatment  on  their  own 
account  that  has  5een  recommended  to  them  by 
some  pamphlet  or  patient.  Some  even  go  so  far 
as  to  substitute  Christian  Science  for  the  regular 
treatment  of  a  sanatorium  while  professing  to  fol- 
low the  latter.  Obviously,  such  a  course  is  ludi- 
crous, and  it  is  equal  folly  to  take  medicines  repom- 
mended  by  friends  who,  of  course,  are  desirous  of 
being  helpful,  but  whose  understanding  is  limited. 

The  medical  profession  is  quick,  perhaps  too 
quick,  to  try  anything  and  everything  that  offers  the 
least  chance  of  being  of  value.  Dr.  Trudeau  very 
truly  writes,  "  As  we  look  back  thirty  years,  it  is 
curious  to  see  how  the  many  widely  heralded  spe- 
cific methods,  aimed  at  the  destruction  of  the  germ 
in  the  tissues,  have  proved  futile,  and  are  now  for- 
gotten, and  how  the  simple  principles  of  treatment 
represented  by  the  first  little  Sanitarium  Cottage 
have  survived,  have  saved  and  prolonged  many 
lives,  and  are  constantly  being  applied  more  and 
more  extensively  and  intelligently  all  over  the 
world."  3 

If  you  would  be  victorious  in  the  fight,  do  not 
experiment  with  uncertain  remedies,  but  through 
thick  and  thin  follow  the  three  cardinal  principles 
of  treatment:  rest,  fresh  air,  and  good  food.  In 
the  battle  against  tuberculosis,  as  in  many  another 
battle,  the  darkest  day  often  comes  just  before  the 
dawn,  and,  at  such  a  time,  to  become  diverted  from 
the  right  course,  because  of  a  tedious  line  of  treat- 
ment, is  to  throw  away  all  that  has  been  gained 
through  years  of  patient  endeavor. 

' "  An  Autobiograph,"  by  E.  L.  Trudeau.  page  206. 
14 


CHAPTER  XXIII 
The  Allies  of  the  Enemy 

In  every  walk  of  life  men  are  realizing  more  and 
mo're  that  tRe  influence  of  the  mind  over  the  body 
is  a  matter  to  which  insufficient  importance  has 
been  attached.  They  are  learning  that  love  and 
hope,  fear  and  excitement,  and  every  emotion 
which  day  by  day  stirs  the  human  heart,  not  only 
stamp  their  imprint  with  indelible  marks  on  every 
feature  of  the  face,  but  finally  engrave  themselves 
upon  the  vital  structures  of  the  body. 

You  have  seen  in  Chapter  XVIII  that  it  is 
impossible  to  think  a  thought  without  there  taking 
place  at  the  same  moment  in  the  brain  tissue  a 
minute  explosion  with  the  consumption  of  oxygen, 
the  throwing  ofif  of  carbonic  gas,  and  the  expendi- 
ture of  energy.  It  is  the  explosion,  in  fact,  which 
produces  the  thought,  and  it  may  be  readily  under- 
stood that  prolonged  and  deep  thinking  requires  a 
great  series  of  explosions  with  the  expenditure  of 
a  corresponding  amount  of  energy.  Thus,  if  you 
were  to  spend  the  day  in  reading  a  book  which  re- 
quires or  causes  deep  concentration  of  the  mind, 
you  would  expend  quite  as  much  energy  as  if  you 
were  to  spend  the  day  performing  physical  exercise. 

The  minute  brain  explosions  which  produce 
thought  are  seldom  completely  under  your  com- 
mand, but  some  are  more  so  than  others,  so  that 
there  may  be  recognized  two  classes  of  thoughts — 

210 


THE  ALLIES  OF  THE  ENEMY  211 

those  which  are  volitional  and  come  forth  at  your 
command  or  desire,  and  those  which  occur  sub- 
consciously and  which  take  place  without  any  direc- 
tion, command,  or  sometimes  even  desire  on  your 
part.  The  subconscious  thoughts  look  after  many 
of  the  everyday  actions  of  your  body,  such  as 
the  guiding  of  your  hands  when  you  convey  food 
to  your  mouth,  while,  at  the  same  time,  your  voli- 
tional thoughts  are  free  to  carry  on  a  conversation 
with  your  dinner  companion.  It  is  well  that  the 
subconscious  mind  should  look  after  the  many  little 
details  of  daily  actions,  as  it  would  become  very 
wearisome  were  you  forced,  before  acting,  to  con- 
centrate your  mind  on  every  little  movement,  such 
as  putting  a  piece  of  bread  in  your  mouth. 

Added  to  one's  everyday  thoughts,  and  insepa- 
rably blended  with  them,  is  that  child  of  feeling, 
emotion,  which  influences  all  thinking,  but  which 
affects,  most  profoundly,  the  subconscious  mind. 
As  soon  as  an  emotion  such  as  fear  begins  to  blend 
itself  with  the  ordinary  thoughts,  the  mind  is 
liable  to  become  over-active  and,  without  desire  on 
your  part,  to  produce  a  series  of  rapid,  profound 
and  often  painful  effects  on  your  body.  Different 
people  are  differently  affected  by  the  ordinary  hapy- 
penings  of  life.  Thus  one  man  will  show  great 
excitement  where  another  will  exhibit  comparative 
indifference.  But  no  matter  what  a  man's  tempera- 
ment may  be  in  health,  he  is  very  much  more  suscep- 
tible to  emotional  excitement  when  he  becomes  ill. 
In  other  words,  the  sick  man  is  much  more  liable  to 
have  his  body  affected  by  his  mind  than  the  well 
man  is.    Moreover,  certain  diseases  unnerve  a  man 


313  THE  BATTLE  WITH  TUBERCULOSIS 

much  more  markedly  than  others  do,  and  amongst 
the  former  tuberculosis  stands  in  the  first  rank.  A 
person  suffering  from  tuberculosis  is  on  the  verge 
of  nervous  excitement  at  all  times,  and  the  little 
things  of  life,  which  in  health  are  passed  over, 
have  often  a  profound  effect  upon  the  invalid's 
mind,  which,  in  turn,  profoundly  interferes  with 
the  normal  working  of  bodily  functions. 

The  emotions  may  be  of  an  acute  or  intense  char- 
acter, such,  for  example,  as  fear,  when  you  think 
you  hear  a  burglar  in  the  house,  and  the  effect  on 
your  body  is  correspondingly  intense — your  face 
pales,  you  feel  cold  chills  running  up  and  down 
your  spine,  a  great  weakness  seizes  your  limbs, 
and  when  the  excitement  is  over  you  feel  exhausted. 
If  you  are  a  woman  quite  possibly  you  fall  in  a 
faint. 

Again,  the  emotion  may  be  less  intense  in  char- 
acter, but  may  become  chronic,  and  give  rise  to  a 
series  of  depressing  thoughts  which  seem  to  weave 
themselves  into  a  circle,  and  revolve  in  the  mind 
with  wearying  and  never-ending  monotony.  Just 
how  much  the  emotion  will  affect  the  body  in  either 
case  depends,  first,  on  the  intensity  of  the  emotion, 
and,  second,  on  the  length  of  time  it  continues 
to  operate.  When  the  emotion  is  of  the  acute  or 
intense  variety,  a  great  deal  of  energy  is  expended 
in  a  short  space  of  time,  as  is  evidenced  by  the 
feeling  of  fatigue  after  the  excitement  has  passed. 
On  the  other  hand,  if  the  emotion  becomes  chronic, 
and  is  continually  alive  in  your  subconscious  mind, 
the  effect  on  the  body  may  not  be  so  evident  to  an 
observer,  perhaps,  but  you  may  lie  quiet  from  mom- 


?p^ 


A,  Section  of  Normal  Cerebellum  (X  3io).  B.  Section  of  Cerebellum  Showing  Effect 
of  Extreme  Emotion  (Fright)  (X3ro).  (From  Crile's  "A  Mechanistic  View  of  War  and 
Peace,"  courtesy  The  Macmillan  Company) 


THE  ALLIES  OF  THE  ENEMY  ai3 

ing  until  night  thinking  you  are  resting  your  body 
and  the  evening  shadows  will  find  you  weary  and 
tired. 

Apart  from  the  expenditure  of  energy  con- 
nected with  all  kinds  of  thought,  there  follows  in  the 
train  of  depressing  emotion  not  only  an  interfer- 
ence with  the  functions  of  the  body,  such  as  indiges- 
tion, but  a  series  of  profound  changes  in  many  of 
the  body's  vital  organs.  Dr.  George  W.  Crile  has 
shown  in  an  interesting  series  of  experiments  a  few 
of  the  changes  wrought.  One  may  see  in  the  ac- 
companying photographs,  prepared  by  Dr.  Crile, 
some  of  the  effects  upon  the  brain  and  the  liver  pro- 
duced by  extreme  fear.*  Dr.  Crile  also  shows  that 
certain  emotions,  such  as  fear  or  anger,  act  in  the 
same  way  as  overwork,  pain,  or  infection,  and 
give  rise  to  a  set  of  symptoms  identical  with  many 
of  those  produced  by  tuberculosis.  If  depressing 
emotion  is  continually  or  repeatedly  in  operation, 
there  follows  in  its  train  one  of 'a  group  of  diseases, 
among  which  tuberculosis  is  most  prominent.  Thus 
we  find  that  certain  emotions  are  promoters  of 
tuberculosis.  In  other  words,  they  are  allies  of  the 
tubercle  enemy,  and  if  you  would  be  victorious  in 
your  long-drawn-out  battle,  you  must  recognize 
which  of  your  emotions  are  assisting  the  enemy, 
and  endeavor  in  so  far  as  possible  to  bring  about  a 
separate  peace  with  them. 

Concerning,  first,  the  volitional  thoughts  or  the 
thinking  that  you  bring  about  by  choice :  it  is  quite 
impossible  to  draw  any  hard-and-fast  line  between 

*  Illustrations  from  "  A  Mechanistic  View  of  War  and 
Peace,"  by  George  W.  Crile,  pages  80  and  84.  With  the  kind 
permission  of  the  author. 


214  THE  BATTLE  WITH  TUBERCULOSIS 

the  thoughts  upon  which  you  may  with  impunity 
allow  your  mind  to  dwell,  and  those  which  it  is 
wiser  that  you  should  avoid.  It  is  a  matter  more 
of  degree  or  intensity  of  thought  than  of  quality  or 
kind  of  thought  which  determines  the  tiring  effect 
upon  your  body.  Thus  you  may  read  one  book 
which  is  mildly  entertaining  and  it  does  you  good, 
provided  you  are  well  enough  to  read  at  all,  but  you 
may  read  another  book  which  holds  your  attention 
so  concentrated  and  which  stirs  your  emotions  so 
deeply  that  when  you  put  it  down  yoiu-  face  is 
flushed,  your  eyes  burn,  your  heart  is  galloping 
like  a  trip-hammer,  and  your  temperature  is  ele- 
vated several  tenths  of  a  degree;  obviously,  the 
second  book  should  be  reserved  for  days  of  health. 

Association  with  some  friends  may  have  a  quiet- 
ing and  steadying  effect,  and  the  conversations  seem 
to  lead  naturally  through  the  most  pleasant  chan- 
nels. Such  associations  are  to  be  sought  and  cher- 
ished. On  the  other  hand,  association  with  an  in- 
dividual of  aggressive,  critical  and  i)erhai>s  cynical 
tendencies  may  seem  to  "  rub  you  up  the  wrong 
way."  Such  associations  form  more  of  a  handi- 
cap to  the  favorable  progress  of  the  tuberculous 
invalid  than  is  generally  realized.'^  Speaking  gen- 
erally, anything  which  deeply  stirs  the  emotions,  or 
whidi  requires  or  causes  deep  concentration  is 
equivalent  tol  strenuous  exercise  and  should  be 
curtailed.  Should  the  emotions  stimulated  be  of  a 
depressing  nature,  like  anger,  such  as  may  arise 
in  a  1  discussion   or  argument,   much  harm  may 

*  For  a  further  consideration  of  nervous  irritaoility  and  its 
treatment  read  "  The  Freedom  of  Life,"  by  Anna  Bayson  CalL 


A.  Section  of  Normal  Liver  (X1640).  B.  Section  of  Liver  Showing  Effect  of  Extreme 
Emotion  (Fright)  (X1640)  (From  Cnle's  "A  Mechanistic  View  of  War  and  Peace," 
courtesy  The  Macmillan  Company) 


THE  ALLIES  OF  THE  ENEMY  215 

result,  and  the  things  which  give  rise  to  such  emo- 
tions must  be  carefully  avoided.  In  a  like  class 
are  all  games  or  pastimes  where  money  is  at 
stake,  or  where  the  excitement  is  intense.  As  a 
result  of  such  excitement  in  tuberculous  people, 
the  following  significant  set  of  symptoms  may  be 
observed:  flushed  face,  tremors,  quickened  pulse, 
quickened  breathing,  raised  temperature  and  dis- 
turbed digestion. 

There  are  few  tuberculous  patients  who  do  not 
early  realize  the  immense  amount  of  energy  it  is 
necessary  to  expend  in  order  to  write  a  letter  that 
will  satisfy  the  demands  of  a  healthy  correspon- 
dent. Unfortunately  it  is  sometimes  exceedingly 
difficult  to  convince  one's  friends,  and  even  one's 
relatives,  of  the  truth  in  this  regard.  There  are 
probably  few  patients,  living  away  from  home,  who 
are  not  subjected  to  a  certain  amount  of  unjust 
criticism  for  delinquencies  on  the  score  of  letter 
writing.  Let  criticisms  and  misunderstandings 
correct  themselves,  as  they  will,  with  time;  your 
business  is  to  win  your  battle,  and  if  writing  letters 
interferes  with  your  progress,  the  letters  must  give 
place  to  postal  cards.  To  recognize  such  things 
as  allies  of  the  enemy  is  all  that  should  be  neces- 
sary to  make  you  avoid  them.  They  are  entirely 
at  your  command,  and  it  is  simply  a  matter  of 
exerting  your  will  to  keep  free  of  them. 

There  is,  however,  another  group  of  thoughts 
which,  while  they  are  under  one's  control,  seem 
nevertheless  to  lie  very  near  the  borderland  of 
volition.     They  sometimes  spring  into  being  un- 


3i6         ,  THE  BATTLE  WITH  TUBERCULOSIS 

heralded,  and  quite  contrary  to  one's  wishes.  They 
are  the  thoughts  which  have  to  do  with  the  sexual 
life  of  the  individual.  If  anything  like  an  accurate 
estimate  could  be  made  of  tuberculous  patients  who 
owe  the  development  of  their  disease  to  sexual  in- 
temperance, it  is  safe  to  say  the  figures  would  be 
appalling.  Could  the  veil  be  lifted  sufficiently  to 
reveal  the  battles  lost  as  the  result  of  the  activities 
of  this  ally  of  the  enemy,  the  absolute  need  of  self- 
control  in  this  regard  would  be  realized  as  never 
before.  In  a  disease  like  tuberculosis,  which  de- 
mands idleness  and  stimulating  food,  it  is  not  to  be 
wondered  at  that  thoughts  of  the  flesh  should  strive 
to  enter  the  mind.  But  the  patient  who  hopes  to 
win  his  battle  must  constantly  regulate  his  mind, 
and  restrict  the  thoughts  he  allows  to  dwell  there. 

Marcus  Aurelius  says,  "  Those  who  do  not  ob- 
serve the  movements  of  their  own  minds  must  of 
necessity  be  unhappy  " ;  also  that,  "  Tranquility  is 
nothing  else  than  the  good  ordering  of  the  mind." 
It  does  not  require  a  philosopher  to  recognize  that 
the  mind  feeds  on  that  which  is  put  before  it,  or  on 
the  things  which  are  voluntarily  chosen  for  it.  If 
a  man  is  going  to  search  journals  for  articles  that 
are  sensual,  if  he  persists  in  indulging  in  suggestive 
or  lewd  conversations  and  stories,  and  if  he  permits 
himself  to  resort  to  places  where  lust  and  impurity 
are  stimulated,  there  js  no  need  for  him  to  read 
further,  for  he  has  not  even  the  first  essential  to 
purity,  viz.,  a  desire  to  be  pure. 

Thoughts  of  desire,  like  a  tree,  are  weak  at  birth, 
and  may  be  crushed  or  rooted  out.     If  nurtured 


THE  ALLIES  OF  THE  ENEMY  217 

and  allowed  to  grow,  they  gain  in  strength.  In 
time  they  become  difficult  even  to  bend;  in  other 
words,  the  ideas  become  fixed.  To  nurture  a 
thought  is  to  allow  It  to  dwell,  to  allow  it  to  in- 
fluence action,  as  putting  the  thought  into  words, 
writing  about  it,  illustrating  it,  metaphorically  or 
literally.  Take,  for  example,  a  sad  thought — in  the 
beginning  it  has  but  little  effect,  but,  pondered  over 
on  all  sides  in  the  mind,  it  causes  pain.  Put  it  into 
words,  quoting  an  example  as  an  illustration,  and 
it  becomes  pictured  in  the  mind  so  vividly  that  it 
causes  enough  pain  to  bring  tears.  If  the  emotion 
be  given  further  sway,  actual  weeping  results,  and 
this  action  of  the  body  greatly  intensifies  the  grief. 

The  treatment  is  obvious.  When  the  first  delicate 
suggestion  enters  the  mind,  crush  it  out;  don't 
nurture  it,  and  ponder  over  it,  until  it  is  too  strong 
to  bend.  But  how  crush  it  out?  By  calling  up 
another  thought,  a  thought  that  brings  opposite 
emotions,  and  by  crystallizing  that  thought  through 
expression,  as  talking  about  it,  writing  about  it, 
illustrating  it,  and,  where  possible,  putting  it  into 
action.  Take  this  example :  A  boy  walks  along  a 
dark  and  lonely  street  where  his  mind  is  likely  to  / 
call  up  the  vision  of  a  holdup,  ready  to  spring  upon 
him  from  every  shadow.  If  he  allowed  the  fear 
to  remain  it  would  grow,  and  he  would  probably 
break  into  a  run,  and,  with  the  body  action  in 
running,  abject  terror  would  seize  him.  But  he  has 
learned  through  experience  that  whistling  calls 
forth  an  emotion  which  combats  fear,  and  so  he 
walks  along  whistling  as  loudly  as  he  can,  and  in  a 
short  time  his  mind  is  riveted  on  the  comic  opera 


2i8  THE  BATTLE  WITH  TUBERCULOSIS 

where  he  heard  the  tune,  and  all  his  fears  vanish. 
Steer  your  course  clear  of  anything  and  every- 
thing that  is  suggestive,  and  when,  for  physiological 
reasons,  the  thoughts  of  animal  passion  come  steal- 
ing into  your  mind  with  seductive  mildness  and 
arrogant  repetition,  become  particularly  busy  with 
thoughts  that  are  high  and  noble,  and  don't  stop 
until  you  have  put  them  into  action  in  the  form  of 
a  sympathetic  word,  or  a  kindly  deed,  which  echoes 
in  the  heart  throughout  the  day. 


CHAPTER  XXIV 

The  Allies  of  the  Enemy  (Continued) 

We  have  seen  that  all  thoughts  may  be  divided 
into  two  classes — voluntary  or  volitional  thoughts, 
and  thoughts  of  the  subconscious  mind.  All  the 
subconscious  thoughts  were  once  upon  a  time 
voluntary  thoughts  which  made  a  deep  impression. 
Thus,  in  babyhood,  the  mind  has  to  be  voluntarily 
concentrated  on  the  putting  forward  of  a  foot  in 
walking,  until  the  impression  in  the  mind  becomes 
so  marked  that  the  act  is  carried  out  subconsciously. 
Certain  thoughts  are  so  intense  that  they  make  a 
marked  impression  from  the  moment  they  come 
into  being.  When  you  were  first  told  that  you 
had  tuberculosis,  the  thought  made  such  a  deep 
impression  that  it  stamped  itself  immediately  on 
the  subconscious  mind,  and  for  some  time  after- 
wards, no  matter  whether  you  laughed  or  sang  or 
slept,  somewhere  from  the  deep  caverns  of  your 
thought  there  boomed  persistently,  "  I  have  tuber- 
culosis, /  have  tuberculosis,  /  have  tuberculosis, 
tuberculosis,  tuberculosis.     .     .     ." 

All  thoughts  which  leave  emotions  in  their 
train  are  more  liable  to  make  a  deep  impression 
than  others,  and  this  seems  to  be  particularly  so 
when  fear  is  the  dominant  emotion.  Fear  is  prob- 
ably the  oldest  emotion  in  the  world.  It  is  seen 
right  down  the  path  of  evolution.  Every  boy 
who  ever  went  fishing  has  witnessed  fear  in  the 

219 


220  THE  BATTLE  WITH  TUBERCULOSIS 

wriggling  fishworm.  It  is  the  emotion  of  self- 
preservation,  and,  without  it,  there  would  be  no 
attempt  to  avoid  danger. 

Fear  may  be  a  very  good  thing,  provided  it  is 
kept  under  control,  and  maintained  at  anything  like 
an  equal  balance.  The  man  who  is  able  to  control 
his  actions,  while  his  mind  is  filled  with  fear,  is 
called  a  brave  man.  He  is  not  brave  because  he 
knows  no  fear,  but  because  when  fear  is  present  he 
controls  it.  On  the  other  hand,  the  man  who  allows 
his  actions  to  be  controlled  by  fear  is  called  a 
coward.  Some  men  are  born  cowards,  others  have 
"  lost  their  nerve  "  as  the  result  of  accident  or  ill- 
ness. .Among  the  latter,  the  ordinary  happenings 
of  life  are  too  liable  to  call  forth  the  emotion  fear. 
Any  happening  which  would  naturally  give  rise  to 
fear  in  a  healthy  person  makes  such  a  profound  im- 
pression on  a  nerve-racked  individual  that  it  not 
only  enters  the  subconscious  mind,  but  it  makes 
the  mind  run  riot.  Such  a  condition  is  commonly 
called  "  worry."  Worry  is  chronic  fear — fear  that 
we  are  going  to  have  a  hemorrhage,  fear  that  we 
are  going  to  die,  fear  that  the  doctor  doesn't  know 
what  he  is  talking  about,  fear  that  something,  we 
don't  know  what,  may  happen,  fear  of  nothing,  and 
a  vague  fear  of  everything.  The  unfortunate  part 
of  it  is  that  the  fear  does  not  come,  be  over  with 
and  go,  as  happens  in  perfect  health ;  instead,  strive 
as  we  may  to  avoid  it,  it  repeats  itself  with  nevef- 
ending  persistency  until  our  appearance  is  altered, 
our  feelings  are  depressed,  our  body  functions  in- 
terfered with,  and  life  itself  becomes  covered  with  a 
great  shadow. 

There  is  little  need  to  recount  the  many  evil 


THE  ALLIES  OF  THE  ENEMY  221 

effects  of  worry ;  it  is  sufficient  to  state  that  in  the 
tuberculosis  battle  worry  is  the  strongest  ally  of 
the  tubercle  enemy.  Many  a  patient  who,  did  he 
have  the  unaided  tubercle  germ  to  fight,  could 
easily  come  out  of  the  struggle  victorious,  falls 
an  easy  victim  to  the  allied  enemies,  tuberculosis 
and  worry.  Herein  lies  the  secret  of  the  occasional 
success  in  tuberculosis  scored  by  Christian  Science. 
This  doctrine  makes  peace  with  fear  or  worry  by 
convincing  the  patient  that  he  has  nothing  wrong 
with  him.  In  order  to  make  him  believe  what,  in 
this  disease  at  least,  is  untrue,  he  is  required  to 
throw  caution  to  the  winds  and  act  like  a  normal 
individual.  The  tremendous  effect  of  the  mind  over 
the  body  is  well  illustrated  in  the  fact  that  occasion- 
ally a  man  suffering  from  tuberculosis  can  discon- 
tinue all  treatment  and  go  to  work,  and  at  the  same 
time  defeat  the  disease,  simply  because  he  has  got 
rid  of  fear  or  worry.  But  the  experiment  is  a  yery 
dangerous  one  and,  unfortunately,  the  failures  are 
not  as  conspicuous  as  the  successes. 

Christian  Science  is  capable  of  doing  good  when 
its  application  is  confined  to  such  cases  as  those  of 
persons  whose  suffering  is  due  largely  to  a  psycho- 
logical breakdown,  but  when  the  application  is  made 
to  the  field  of  organic  disease,  it  is  difficult  to  place 
limits  to  the  harm  it  may  do.  When  tempted  by 
any  form  of  faith  or  miracle  cure,  a  tuberculous, 
patient  should  think  twice  before  he  stakes  his  life 
on  any  course  which  ignores  a  change  in  the  lungs 
as  apparent  as  it  is  serious.  It  is  well  that  the 
patient  should  get  rid  of  fear,  but  if  in  so  doing 
he  at  the  same  time  gives  up  that  good  product  of 


323  THE  BATTLE  WITH  TUBERCULOSIS 

fear  called  caution,  his  chances  of  recovery  are,  to 
say  the  least,  greatly  reduced.  It  would  have  been 
quite  impossible  for  Christian  Science  to  thrive  as 
it  has  done  had  it  not  contained  in  its  doctrine  some 
important  elements  of  truth.  In  its  teaching  that 
man  must  be  in  accord  with  God  before  he  can  hope 
to  have  peace  of  mind,  it  is  heralding  one  of  the 
"  unwritten  and  unchanging  laws  of  Heaven — ^laws 
that  are  not  of  to-day  or  yesterday,  but  abide  for- 
ever, and  of  their  creation  knoweth  no  man."  * 
Without  accepting  that  which  in  the  literal  sense 
every  man  must  feel  to  be  untrue,  we  may  take  the 
gold  and  leave  the  dross,  and  gain  for  ourselves  all 
that  Christian  Science  can  give,  and  more. 

Worry  is  fear,  but  why  are  we  afraid  ?  Simply 
because  we  want  our  own  way,  and  we  have  a  de- 
pressing inward  fear  that  we  won't  get  it,  and  so  we 
proceed  to  be  unhappy  and  to  make  everybody 
aroimd  us  unhappy.  Suppose  that  one  of  your 
white  cells  should  come  to  the  conclusion  that  he 
was  not  content  to  travel  in  the  same  direction  in 
which  it  was  necessary  that  the  blood-stream  should 
carry  him.  Suppose  that  he  thought  he  would  be 
happier  carrying  oxygen  instead  of  being  a  scav- 
enger, and  further  made  up  his  mind  that  he  was 
going  to  carry  oxygen.  What  would  happen  ?  He 
would  continue  to  travel  in  the  same  direction  in  the 
blood-stream  and  he  would  continue  to  be  a  scav- 
enger until  he  died  of  worry  or  fear  that  he  was 
not  going  to  get  his  own  way.  The  relation  of  the 
white  cell  to  your  body  is  a  feeble  example  of  your 
relation  to  God.     Perhaps  you  prefer  to  call  God, 

*  Sophocles'  "Antigone,"  line  450  S. 


THE  ALLIES  OF  THE  ENEMY  saj 

Nature.  The  Mohammedan  calls  Him,  Allah ;  the 
[Buddhist  calls  Him,  Buddha,  and  Christians  find 
Him  revealed  in  Christ.  But  God,  by  any  other 
name,  is  just  as  powerful,  and  it  matters  little 
by  what  name  you  prefer  to  call  Him,  provided 
you  begin  to  realize  His  almighty  power,  and 
the  complete  insignificance  of  yourself  by  com- 
parison— how  little  you  matter  in  "  the  scheme  of 
things  entire." 

We  come  into  a  world  where  certain  inflexible 
laws  operated  for  millions  of  years  before  we 
were  ever  thought  of.  These  same  laws  operate 
to-day.  They  are  never  suspended,  and  they  always 
operate  toward  the  one  end  of  harmony  and  per- 
fection. Anything  and  everything  which  attempts 
to  thwart  these  laws  is  slowly  but  surely  eliminated, 
is  thrust  out,  dies.  And  so  it  comes  about  that 
every  action  which  is  out  of  accord  with  these  laws, 
and  every  thought  which  is  out  of  accord  with  these 
laws,  is  automatically  followed  by  damage,  and  is 
a  step  towards  death,  whilst  every  action  and 
thought  which  is  in  accord  with  these  laws  auto- 
matically brings  about  development  and  building 
up.  You  are  not  suffering  from  tuberculosis  be- 
cause a  frowning  Providence  seeks  to  punish  you, 
although  such  a  thought  contains,  in  metaphorical 
terms,  the  true  philosophy.  You  are  suffering  from 
tuberculosis  as  a  direct  consequence  of  an  attempt 
on  the  part  of  yourself  or  your  forefathers  to  do 
what  you  yourselves  wanted,  irrespective  of  the  re- 
quirements of  Nature.  Many  of  Nature's  laws  are 
unwittingly  disobeyed  because  they  are  not  under- 
stood, but  whether  understood  or  not,  the  results  of 
the  disobedience  are  equally  unfortunate.    Science 


334  THE  BATTLE  WITH  TUBERCULOSIS 

is  God's  highest  servant  in  that  it  ever  strives  to 
throw  light  on  the  laws  of  Nature,  and  to  bring 
man's  actions  and  thoughts  into  harmony  with  the 
divine  purpose.  We  must  endeavor  to  arrive  at  a 
proper  understanding  of  the  laws  of  Nature,  and  to 
carry  out  these  laws  to  the  best  of  our  ability. 
Without  the  knowledge  that  we  are  giving  up  every- 
thing that  tends  to  operate  against  Nature,  and  with- 
out the  knowledge  tha.t  we  are  doing  everything  in 
our  power  to  assist  Nature,  we  are  bound  to  worry, 
and  it  is  well  that  we  sho\ild,  as  worry  is  then  the 
torture  which  tends  to  drive  us  back  to  what  is  right, 
and  to  what  will  prolong  our  lives.  Once  in  our 
inmost  consciences,  we  know  that  we  have  given  up 
all  pleasure,  and  renounced  everything  that  is  inter- 
fering with  Nature,  and  that  we  are  doing  all  in  our 
power  to  assist  Nature,  we  are  able  to  shift  the  re- 
sponsibility from  our  own  shoulders  and  to  say,  "  I 
am  doing  everything  I  can,  the  rest  must  be  left  to 
forces  greater  that  I  am."  This  is  the  first  step  in 
overcoming  worry. 

The  second  step  is  the  cultivation  within  our- 
selves of  a  willingness  to  make  the  best  of  the 
road  we  travel,  even  though  it  leads  down  into  the 
valley  of  the  shadow.  In  his  autobiography ,2  Dr. 
E.  L.  Trudeau  says :  "  I  had  to  give  up  work, 
however,  and  as  sickness  was  a  new  experience 
to  me  at  that  time  I  rebelled  and  struggled  against 
it,  and  was  thoroughly  unnerved  by  it.  I  have 
had  ample  opportunity  in  the  past  forty  years  to 
get  used  to  illness  and  suffering,  but  it  took  me 
a  long  time  to  learn,  imperfectly  though  it  be,  that 
acquiescence  is  the  only  way  for  the  tuberculous  in- 

« Page  74. 


THE  ALLIES  OF  THE  ENEMY  225 

valid  to  conquer  fate.  To  cease  to  rebel  and 
struggle,  and  to  learn  to  be  content  with  part  of  a 
loaf  when  one  cannot  have  a  whole  loaf,  though  a 
hard  lesson  to  learn,  is  good  philosophy  for  the 
tuberculous  invalid,  and,  to  his  astonishment,  he 
often  finds  that  what  he  considers  the  half  loaf, 
when  acquiesced  in,  proves  most  satisfying.  It  was 
many  years,  however,  before  I  learned  this  great 
lesson,  but  when  once  learned  it  made  life  fuller 
and  happier."  Dr.  Trudeau's  experience  is  the  ex- 
perience of  many  a  man.  "  Acquiescence  in  fate  " 
does  not  come  in  a  day  or  in  a  year,  but  requires 
humility,  unselfishness  and  nobility  of  character, 
and  such  virtues  are  slow  in  the  making. 

We  have  seen  that  one  thought  is  capable  of  com- 
bating and  effacing  another  thought.  When  the 
worry  thoughts  fill  our  minds,  while  it  is  not  pos- 
sible to  efface  them  and  leave  our  minds  a  blank,  it 
is  quite  possible  to  call  into  being  other  thoughts  of 
a  happy  character  which  will  supplant  or  combat  the 
worry  thoughts.  This  will  prove  more  successful 
when  the  happy  thoughts  are  put  into  action.  Fur- 
ther, if  the  happy  thoughts  have  to  do  with  some- 
body other  than  ourselves,  or  are  happy,  unselfish 
thoughts,  another  irritating  ingredient  of  the  worry 
thought  is  neutralized.  The  everyday  method  of 
combating  worry  is  to  go  in  search  of  a  good  time, 
in  the  belief  that  the  more  excitement,  the  better. 
To  be  sure,  worry  is  drowned  for  the  time  being; 
but  there  results  that  which  promotes  worry  more 
than  anything  else,  namely,  fatigue,  and  just  as  soon 
as  the  excitement  is  over,  worry  returns  with  sharp- 
ened claws.  On  the  other  hand,  if  you  combat 
15  "* 


226  THE  BATTLE  WITH  TUBERCULOSIS 

worry  by  a  kindly  action,  your  mind  is  diverted 
from  yourself,  there  is  not  as  much  room  for  worry 
to  find  an  entrance,  and  the  reward  of  service  to 
others,  a  happy  heart,  is  yours  for  the  remainder 
of  the  day. 

As  already  pointed  out,  not  only  worry,  but 
every  depressing  emotion,  may  be  combated  by 
an  action  which  habitually  accompanies  an  opposite 
emotion.  For  example,  when  you  feel  your  temper 
particularly  disturbed,  or  sadness  thrusting  itself 
upon  you,  or  jealousy  attempting  to  devour  you,  if 
you  force  yourself  to  laugh,  whistle,  or  sing,  the 
edge  is  taken  off  the  anger,  jealousy  or  sadness. 
Never  allow  a  depressing  emotion  to  find  expression 
in  word  or  action,  because  the  word  or  action  in- 
tensifies it.  By  constantly  cultivating  the  happy 
emotions,  you  will  soon  realize  that  preventive 
treatment  is  more  efficacious  than  waiting  for 
trouble  before  applying  the  cure. 

Many  a  man  finds  his  true  help  and  support  in 
prayer.  "  More  things  are  wrought  by  prayer  than 
this  world  dreams  of."  Auto-suggestion  has  also 
helped  many  who  have  found  it  difficult  to  pray. 
In  your  every  thought  and  action  your  mind  re- 
sponds to  suggestion,  either  your  own  or  another's. 
,Why  not  intensify  your  highest  thoughts  and  de- 
sires byputting  them  into  words  and  by  telling  your- 
self what  the>  are?  It  works  successfully  just  in 
proportion  to  the  earnestness  and  perseverance  you 
expend  on  it.  The  suggestion  should  be  positive, 
not  negative ;  it  should  be  made  at  a  time  when  you 
are  relaxed  and  peaceful,  and  preferably  Nvhen 
the  volitional  thoughts  are  somewhat  in  abeyance, 
as  during  the  moments  when  sleep  begins  to  shadow 


THE  ALLIES  OF  THE  ENEMY  227 

the  mind,  or  wakefulness  knocks  softly  at  the  door 
of  consciousness.  Perhaps  some  thoughts  like  these 
will  take  the  form  of  words — "  During  this  day, 
I  will  be  watchful  for  every  opportunity  of  service 
to  those  about  me.  I  will  forget  myself  in  my 
thought  for  others.  I  will  be  sympathetic,  kind, 
and  cheerful.  I  will  put  the  wishes  of  others  be- 
fore my  own,  and  find  my  truest  happiness  and 
peace  of  mind  in  the  happiness  and  peace  of 
mind  I  can  bring  to  others."  Not  once  or 
twice,  but  every  day,  and  several  times  a  day,  must 
these  and  other  suggestions  be  made,  and  perhaps 
when  a  month  has  passed  you  will  find  the  mind, 
like  a  humble  child,  ready  to  act  on  your  bidding, 
and  ready  to  follow  the  path  of  peace. 

All  of  this  you  will  say  is  nothing  but  religion. 
It  is  religion,  devoid  of  dogma.  It  is  the  religion 
in  which  you  must  become  most  seriously  interested 
if  you  would  make  peace  with  the  allies  of  the 
enemy.  Professor  William  James  says :  ^  "  The 
sovereign  cure  for  worry  is  religious  faith.  The 
turbulent  billows  of  the  fretful  surface  leave  the 
deep  parts  of  the  ocean  undisturbed,  and  to  him  who 
has  a  hold  of  vaster  and  more  permanent  realities 
the  hourly  vicissitudes  of  his  personal  destiny  seem 
relatively  insignificant  things." 

Many  times  failure  will  come,  many  times  utter 
discouragement  will  come,  but  with  a  determination 
"  to  strive,  to  seek,  to  find,  and  not  to  yield,"  pride 
will  be  finally  humbled,  selfishness  will  be  subdued, 
and  "  a  pveace  which  passes  all  understanding  "  will 
find  expression  in  the  words  of  submission,  "  Thy 
will,  not  mine,  be  done." 

'"Talks  with  Teachers  on  Psychology  and  Life's  Ideals." 


CHAPTER  XXV 
The  End  of  the  Battle 

To  speak  truly,  the  battle  really  never  ends.  Al- 
though, in  time,  the  beacons  of  the  enemy  burn  but 
dimly  in  the  distance,  once  there  has  been  a  battle 
we  must  sleep  forever  after  with  our  arms  beside 
us  and  go  through  life  ready,  always  ready,  for  the 
surprise  attack.  Tuberculosis  is  essentially  a  "re- 
lapsing disease,"  i.e.,  the  enemy  comes  back  when  » 
given  the  least  encouragement.  On  the  other  hand, 
of  all  chronic  diseases,  it  is  the  most  easily  arrested, 
and  in  this  fact  lies  its  greatest  danger.  The  aver- 
age patient,  provided  he  has  signs  of  trouble  con- 
stantly before  him,  will  follow  the  necessary  treat- 
ment faithfully,  but,  when  the  symptoms  have  dis- 
appeared, it  is  difficult  to  make  him  realize  the 
necessity  for  keeping  quiet.  Thus  it  is  that  too 
often  he  gets  about  before  the  disease  is  sufficiently 
healed,  with  the  result  that  there  is  a  relapse  and 
the  same  process  of  treatment  has  to  be  gone  through 
with  again.  Eventually  his  life  becomes  one  series 
of  periods  of  arrest  and  relapse,  until  finally  a  time 
arrives  when  it  is  impossible  for  him  to  make  an 
arrest,  and  there  follow  the  closing  scenes  of  a 
battle  that  has  been  won  a  dozen  times,  and  lost  as 
many  simply  because  it  was  too  easily  won. 

Sanatorium  statistics  show  that  only  a  few  more 
than  50  per  cent,  of  incipient  cases  are  alive  fifteen 
years  after  discharge,  that  50  per  cent,  of  those 
228 


THE  END  OF  THE  BATTLE  229 

with  moderately  advanced  tuberculosis  are  dead  in 
six  years,  and  that  one  out  of  every  two  cases,  dis- 
charged with  the  disease  "arrested  "  (term  as  used 
previous  to  19 13),  dies  within  six  years'  time.  On 
the  other  hand,  40  per  cent,  of  the  patients  who 
enter  a  sanatorium  with  tubercle  bacilli  in  their 
sputum  lose  them  during  residence  there.  At  the 
Adirondack  Cottage  Sanatoriiun,  34  per  cent,  of 
the  patients  got  rid  of  their  tubercle  germs  in  six 
months,  and  43  per  cent,  in  one  year.  Why  is  it 
then,  when  patients  improve  so  rapidly  under  sana- 
torium treatment,  that  they  go  to  pieces  so  quickly 
on  their  own  resources?  Simply  because  they 
have  not  enough  of  two  requisites:  Self-control 
and  money. 

Tuberculosis,  as  a  rule,  takes  years  to  heal ;  the 
best  cures  are  made  in  from  three  to  five  years. 
You  imagine,  as  every  patient  imagines,  that  you 
are  quite  an  exception  to  this  rule,  because  you 
have  such  a  small  amount  of  trouble,  but  although 
the  truth  may  be  distasteful  to  you,  by  all  means 
accept  and  act  upon  it.  Treatment  should  be  car- 
ried out  most  carefully  the  first  two  years.  After 
that,  imder  favorable  conditions,  accompanying 
treatment,  a  small  amount  of  work  may  be  un- 
dertaken. It  is  a  mistake  to  suppose  that  any  one 
day  will  arrive  when  you  will  walk  forth,  and,  meta- 
phorically speaking,  hoist  the  flag  of  victory.  Many 
a  man  comes  gaily  out  of  the  doctor's  office  with 
the  information  that  his  condition  is  apparently 
arrested,  and  goes  out  into  the  world  with  an  ab- 
solutely fatal  mental  attitude.     He  supposes  that 


230  THE  BATTLE  WITH  TUBERCULOSIS 

all  his  troubles  are  over,  that  he  can  start  in  and 
live  as  he  did  before  his  illness,  and  that,  because 
the  doctor  has  said  his  condition  is  apparently  ar- 
rested, he  is  free  from  all  further  restrictions. 
Much  of  this  mental  attitude  comes  from  a  false 
understanding  of  words.  An  apparently  arrested 
case  is  one  in  which  all  constitutional  symptoms, 
that  is  fever,  weakness,  etc.,  have  been  absent  for 
a  period  of  three  months.  Likewise,  cough,  and 
tubercle  bacilli  in  the  expectoration,  must  have  been 
continuously  absent  for  a  similar  time.  The  signs 
of  battle  in  the  chest,  as  heard  by  the  doctor,  must 
indicate  that  the  tubercle  germ  is  quite  imprisoned. 
But  this  result  has  been  reached  in  all  probability 
under  invalid  conditions,  and  what  the  results  will 
be  under  working  conditions  is,  as  yet,  quite 
unknown. 

An  arrest,  according  to  the  officially  accepted 
meaning  of  the  term,  may  be  said  to  exist  only  when 
an  apparent  arrest  has  gone  forward  without  inter- 
ruption for  six  months. 

There  is  no  such  thing  as  a  cure  in  the  official 
classification,  but  an  apparent  cure  may  be  said  to 
exist  when  no  constitutional  s5miptoms,  no  cough, 
no  expectoration  with  tubercle  bacilli  has  occurred 
for  a  period  of  two  years.  Also  the  physical  signs 
must  show  that  the  enemy  has  been  completely  im- 
prisoned for  a  similar  time,  and  all  this  must  have 
prevailed,  not  under  an  invalid  regime,  but  under 
the  ordinary  conditions  of  life. 

In  view  of  these  strict  definitions,  it  is  difficult 
to  understand  the  statements  of  certain  patients 
who,  after  a  few  months'  sojourn  at  a  sanatorium, 


THE  END  OF  THE  BATTLE  231 

come  from  an  examination  by  the  doctor  and  with 
bland  innocence  announce  that  the  doctor  has  pro- 
nounced them  "  a  cure,"  or  has  said  that  they  would 
be  a  cure  in  two  or  three  months.  Apparently  it 
is  possible  for  some  patients  to  so  desire  a  certain 
result  that  they  can  deceive  themselves  into  believ- 
ing it  exists,  and,  by  deceiving  others,  finally  con- 
vince themselves.  Such  self-deception  accounts 
for  many  deaths. 

You  must  make  a  very  clear  distinction  in  your 
mind  between  immediate  results  and  ultimate  re- 
sults. Suppose  the  immediate  result  of  your  treat- 
ment at  a  sanatorium  to  be  an  arrest.  Very  good, 
it  is  something  of  which  to  feel  proud.  But  it  is 
by  no  means  a  guarantee  that  a  return  to  ordinary 
living  will  not  bring  about  a  relapse.  Indeed,  the 
chances  are  one  in  two  that  a  return  to  normal  living 
will  result  in  a  relapse.  An  arrest  simply  means 
that  you  have  come  to  the  place  where  you  may 
begin  to  try  and  find  out  just  how  much  work  and 
play  is  compatible  with  ultimately  good  results. 
Life  lies  before  you  if  you  feel  your  way.  Ultimate 
failure  will  be  yours  if  you  plunge. 

It  sometimes  happens  that,  in  spite  of  his  condi- 
tion, a  patient  who  has  not  even  secured  immediate 
results  recovers  comparatively  good  health  through 
taking  up  some  line  of  service  which  at  the  outset 
does  not  tax  him  too  severely.  To  every  man  of 
the  right  spirit  there  comes  a  time  when  he  feels 
that  merely  to  exist  is  no  longer  tolerable;  there 
comes  a  time  when  death  itself  is  to  be  preferred  to 
life  without  some  degree  of  usefulness,  and  when,  in 
short,  he  is  going  to  take  the  chance.    Should  such 


232  THE  BATTLE  WITH  TUBERCULOSIS 

a  time  arrive  in  your  life,  be  sure  to  reflect  carefully 
on  what  is  due  to  those  who  have  invested  on  your 
life,  and  remember  that  Dr.  Trudeau  did  his  great- 
est work  after  spending  eight  long,  weary  years 
staring  death  in  the  face.  Some  men,  after  many 
years  of  apparently  fruitless  endeavor  to  regain 
their  health,  have  taken  the  chance  and,  partly 
through  making  a  careful  beginning,  have  found 
an  unexpected  reward  in  service  to  others.  On  the 
other  hand,  many  have  passed  on  to  find  their  re- 
ward in  another  world.  "  Familiarity  luckily  re- 
moves many  stings,  and  he  who  faces  death  con- 
stantly often  comes  to  face  it  fearlessly."  Should 
the  end  of  the  battle  bring  death,  you  who  have 
played  on  the  football  field  will  know  how  to  accept 
defeat  like  "  a  valiant  man  and  true,"  and  you  who 
have  learned  the  blessed  teaching  of  renunciation 
will  realize  that  in  your  very  death  you  can  teach 
one  of  the  greatest  lessons  of  life — an  unselfish  re- 
gard for  the  feelings  of  others. 

When  the  time  comes  for  branching  out  into  new 
activities,  if  you  would  know  how  to  proceed, 
watch  the  change  of  season,  watch  the  summer 
giving  way  to  winter.  The  hard  frost  does  not 
come  suddenly  out  of  a  summer  night,  but 
gradually,  by  what  may  be  termed  hesitating  pro- 
gression, the  warm  days  and  nights  give  place  first 
to  a  few  cool  nights,  which  in  turn  are  followed  by 
days  and  nights  that  are  warmer  but  not  quite  so 
warm  as  those  which  went  before.  And  so  the 
cooler  season  advances  by  steps  which,  as  it  were, 
are  partially  retracted  as  if  to  observe  the  results 


THE  END  OF  THE  BATTLE  233 

of  the  advance.  Thus  all  Nature  is  given  an  oppor" 
tunity  to  adjust  itself  to  the  change. 

Your  term  of  hesitating  progression  starts  not  on 
the  day  you  leave  the  sanatorium,  but  on  the  first 
day  you  take  up  exercise.  At  first  very  slowly  in- 
deed, you  extend  a  little,  drop  back  a  little,  but  not 
as  far  as  the  first  time^  extend  a  little  further  than 
on  the  first  occasion,  drop  back,  and  so  on  until 
finally  you  reach  four  to  six  hours  of  walking  be- 
fore you  start  to  progress  in  some  other  direction, 
such  as  taking  up  office  work.  Always  remember 
the  new  activity,  such  as  office  work,  must  replace 
and  not  he  added  to  the  old  activity.  At  the  begin- 
ning you  cannot  expect  to  both  work  and  play.  If 
you  choose  work,  you  must  rest,  not  play,  when 
work  is  over.  More  relapses  occur  from  over-exer- 
tion in  sport  than  from  overwork.  If  the  work  in 
which  you  engage  keeps  you  indoors  during  the 
day,  it  is  highly  important  for  you  to  sleep  outside 
on  a  porch  at  night. 

The  more  nearly  the  environment  under  which  a 
patient  takes  up  new  activities  approximates  that 
under  which  he  has  been  taking  his  treatment,  the 
better  the  outlook  for  the  future  enjoyment  of 
good  health.  Many  a  patient  effects  his  undoing 
because  he  is  not  aware  that,  on  returning  from  a 
high  to  a  low  altitude,  there  has  to  be  a  readjust- 
ment of  his  circulation,  just  as  an  adjustment  in 
another  way  had  to  take  place  on  going  to  a  high 
altitude.  Unfortunately,  immediately  following  a 
change  in  altitude,  there  is  generally  a  very  great 
temptation  to  overdo,  because  the  change  usually 
involves  a  big  celebration  on  arriving  home  after  a 


234  THE  BATTLE  WITH  TUBERCULOSIS 

long  and  tiring  journey.  This  is  where  many  a 
patient  makes  a  bad  start  from  which  he  never  re- 
covers. Also  herein  Hes  the  strongest  argument  of 
doctors  who  oppose  change  of  climate  for  tubercu- 
lous patients.  Change  of  climate  generally  does 
good.  It  is  the  foolish  excesses  to  which  patients 
go  immediately  after  returning  that  works  the 
havoc. 

When  you  leave  the  sanatorium  to  go  home,  or 
to  take  up  your  residence  in  any  different  environ- 
ment, remember  that  the  change  renders  you  more 
vulnerable  to  physical  mishap  for  at  least  a  month, 
and  that,  for  that  time  at  least,  not  only  should"  you 
refrain  from  taking  up  new  activities,  but  you 
should  curtail  to  a  certain  extent  the  amount  of 
activity  to  which  you  are  already  accustomed.  If 
the  change  involves  a  different  altitude,  whether 
high  or  low,  it  is  all  the  more  important  to  be 
cautious.  On  arriving  home,  carry  out  the  rest 
hours  and  all  the  sanatorium  rules  just  the  same  as 
you  have  been  doing,  and  when,  after  a  month's 
time,  you  are  thoroughly  rested  and  acclimated, 
begin  to  feel  your  way  into  such  new  activities  as 
the  doctor  has  advised  you  are  permissible.  If  you 
are  still  raising  sputum,  re-read  Chapter  XVII, 
"  The  Beginning  of  the  Battle,"  and  carry  out  care- 
fully the  details  there  outlined. 

Is  it  necessary  to  go  on  taking  your  temperature  ? 
When  temperature  has  been  continuously  normal 
for  some  months,  the  reading  of  the  thermometer 
may  be  limited  to  Saturday  afternoon  and  evening 
of  each  week.  As  you  become  more  confident  that 
there  is  no  rise  above  normal,  the  interval  may  be 


THE  END  OF  THE  BATTLE  235 

lengthened  to  a  fortnight,  and  later  it  will  be  suffi- 
cient to  take  your  temperature  on  the  first  two  or 
three  days  of  each  month.  Very  often  towards  the 
end  of  the  battle,  it  is  highly  important  to  develop 
a  state  of  mind  which  is  unconcerned  about  tem- 
perature or  pulse.  The  long  habit  of  watching 
closely  your  temperature's  fluctuations  is  liable  to 
lead  to  a  harmful  degree  of  introspection,  and  when 
the  doctor  considers  it  wise  to  "  forget  it,"  al- 
though a  most  difficult  thing  to  accomplish,  it  is 
well  once  again  to  prove  your  self-control,  or  rather 
your  ability  to  forget  yourself,  and  carry  out  orders 
to  the  letter. 

The  doctor  will  inform  you  regarding  what  is 
advisable  in  the  way  of  visiting  him.  Generally  for 
the  first  few  years  after  beginning  graduated  work, 
it  is  well,  at  least  once  a  year,  to  go  to  a  specialist 
and  have  a  thorough  examination,  Including  an 
X-ray  picture  of  your  chest.  The  latter  will  give 
most  valuable  information  regarding  your  progress. 

At  least  once  a  year  you  should  take  a  complete 
rest  and  change.  If  you  have  become  an  apparent 
cure,  it  is  permissible  for  you  to  indulge  moderately 
in  golf  and  croquet,  fishing  and  hunting,  rowing 
and  paddling,  skating,  skeeing,  snow-shoeing,  or 
bicycle  riding,  swimming,  or  horseback  riding  in 
careful  moderation. 

Finally  comes  the  question  of  marriage,  a  ques- 
tion which  each  individual  patient  or  ex-patient 
must  decide  in  consultation  with  his  doctor,  and 
after  weighing  carefully  all  of  the  considerations. 
Normal  marriage  generally  means  propagation,  and 
you  must  determine  whether  or  not  you  consider 


236  THE  BATTLE  WITH  TUBERCULOSIS 

it  right  to  become  the  father  or  mother  of  a  child 
who,  on  account  of  your  infirmity,  will  be  predis- 
posed to  undergo  a  like  suffering  to  that  which  has 
been  yours.  Then  there  is  the  more  selfish  aspect. 
Osier  very  truly  says,  "If  a  woman,  threatened  with 
phthisis,  marries,  she  may  bear  one  accouchement 
well,  a  second  with  difficulty,  and  a  third  never."  ^ 
Also  the  intimate  relations  characteristic  of  early 
married  life  are  undoubtedly  a  menace  to  either 
party  not  already  tuberculous,  unless,  of  course,  the 
ex-patient  is  "  an  arrest,"  according  to  the  official 
interpretation  of  the  phrase.  The  danger  of  in- 
fection to  husband  or  wife,  however,  is  not  nearly 
so  great  as  it  is  to  the  children. 

On  the  other  hand,  where  reason  is  capable  of 
outweighing  emotion,  where  the  head  can  control 
the  heart,  there  is  much  in  the  good-fellowship  and 
soberness  of  a  sane  married  life  which  makes  for 
uplift  of  mind  and  body.  It  is  quite  impossible  to 
formulate  any  specific  rules  for  a  state  the  consum- 
mation of  which  should  depend  upon  the  person- 
ality, self-control,  circumstances,  and  physical  con- 
dition of  each  individual.  Should  marriage  take 
place,  the  wife  should  know  that  conception  ensuing 
before  a  term  of  two  years  of  good  health  has  ex- 
pired will  cause  quite  possibly  renewed  activity  in 
the  chest.  If  finances  are  such  that  a  woman  must 
work  while  pregnant,  a  like  result  may  be  expected. 
In  any  event,  following  confinement,  all  ex-patient 
mothers  should  have  recourse  to  the  rest  cure  for 
several  months. 

*  Osier's  "Modern  Medicine,"  vol.  iii,  page  326, 


THE  END  OF  THE  BATTLE  237 

There  are  many  factors  which  determine  whether 
the  battle  will  end  in  provisional  victory  or  defeat. 
Some  factors  are  quite  beyond  the  influence  of 
human  endeavor,  but  of  the  others  which  lie  within 
your  power  to  effect,  self-control  is  the  greatest. 
Whether  the  end  of  the  battle  bring  victory  or 
whether  it  bring  defeat,  "  to  travel  hopefully,"  as 
Stevenson  says,  "  is  better  than  to  arrive,  and  the 
true  success  is  in  labor." 


CHAPTER  XXVI 
The  Spoils  of  War 

In  the  olden  days,  it  was  not  unusual  for  war- 
riors to  come  from  far  fields  of  conflict  laden  with 
the  spoils  of  war.  The  seasoned  veterans  would 
exhibit  their  treasures  and  tell  with  pride  of  the 
subjugation  of  the  enem)'-  and  of  the  glories  of 
victory.  But  in  the  army's  hosts  there  were  always 
many  who  had  failed  to  find  treasure  or  glory,  many 
who  had  found  in  the  conflict  nothing  but  priva- 
tion and  hardship,  disappointed  ambition,  ruin  and 
sorrow.  And  so  it  is  in  the  battle  against  tuber- 
culosis— one  man  finds  in  the  conflict  the  richest 
of  life's  treasures,  while  another  realizes  only  bitter- 
ness and  disappointment. 

In  the  first  place,  one  must  know  that,  although 
they  are  hidden,  there  are  treasures  to  be  found  by 
searching,  and  that  they  are  often  hidden  in  what, 
to  the  unsophisticated  recruit,  would  appear  to  be 
the  most  unexpected  places.  Again,  one  may  know 
where  the  treasures  are  hidden,  but  may  lack  in  the 
perseverance  or  even  the  desire  to  become  possessed 
of  them.  It  is  a  fact  that  in  this  world  we  often 
get  what  we  most  desire,  and  those  things  which 
we  do  not  obtain,  we  are  denied  simply  because  we 
do  not  want  them  badly  enough. 

Time  is  a  peculiar  kind  of  treasure  which  is  much 
sought  after  by  the  world.  The  lack  of  it  is  the 
excuse  for  the  failure  in  carrying  out  many  good 
238 


THE  SPOILS  OP  WAR  239 

intentions.  But  when  time  comes,  as  it  does  in 
abundance  to  every  fighter  of  the  tuberculosis  battle, 
how  it  is  despised,  how  it  is  killed !  You  who  are 
beginning  your  battle,  are  you  going  to  kill  time  for 
the  next  two  or  more  years,  or  are  you  going  to 
find  in  it  spoils  of  war  which  will  bring  you  happi- 
ness and  power  unrealized  before?  Perhaps  you 
are  very  ill,  too  ill  you  think  to  write  or  read  or 
make  use  of  time  for  things  that  count.  Quite  true, 
you  must  rest  and  not  weary  your  mind  with  that 
which  is  tiring.  But  the  mind,  especially  the  mind 
of  the  tuberculous  patient,  refuses  to  be  a  blank. 
If  it  be  not  occupied  with  one  thing,  it  will  be  oc- 
cupied with  another,  and  one  of  the  finest  oppor- 
tunities of  the  battle  is  that  of  acquiring  the  ability 
to  lead  the  mind  into  paths  which  are  uplifting,  and 
at  the  same  time  restful.  No  matter  how  weary 
you  are,  how  much  better  to  fill  the  mind  with  the 
silent  wonders  of  Nature  than  to  count  the  cracks 
in  the  ceiling,  or  worry  about  what  "  he  said  to  her  " 
or  what  "  she  said  to  him."  Even  if  you  are  a 
prisoner,  confined  to  bed  on  your  porch,  there  may 
be  hung  on  the  wall  little  mottoes  which  will  con- 
stantly recall  the  mind  to  thoughts  that  are  high 
and  noble.  There  may  be  pictures  which  are  inspir- 
ing and  rich  in  memories.  In  a  mirror  suitably 
hung  there  may  also  be  reflected  the  living,  ever- 
changing  picture  of  the  out-of-doors.  In  the  sum- 
mer time,  you  may  watch  with  wonder  the  bursting 
bud  of  a  fragrant  flower  on  the  table  by  your  bed- 
side, or  you  may  find  another  diversion  in  the 
agility  and  grace  of  a  goldfish  as  he  glides  through 
the  water  in  his  big  glass  bowl.     In  the  cold  of 


240  THE  BATTLE  WITH  TUBERCULOSIS 

winter,  there  is  nothing  more  beautiful  than  to  see 
constructed  before  your  very  eyes  the  dehcate  archi- 
tecture of  the  frost  king  as  he  builds  his  castle  of 
ice  in  the  tumbler  of  water  on  the  table.  Each  is  a 
very  little  thing,  to  be  sure,  but  it  is  the  summation 
of  little  things  that  makes  or  mars  a  man. 

Later,  when  the  first  feverish  flare-up  of  the 
battle  has  subsided,  there  comes  an  opportunity  to 
get  back  to  that  from  which  we  all  have  strayed  too 
far — that  something  which  is  taught  us  by  the  blue- 
bird as  she  builds  her  nest  just  near  where  we  lie — 
that  something  which  we  see  in  the  lights  and 
shadows,  in  the  heights  and  depths  of  some  moun- 
tain vastness — that  something  which  we  feel  in  the 
"  wild  witchery  of  the  winter  woods."  Who  like 
you  has  equal  time  to  garner  in  Nature's  treasures 
and  to  receive  the  benediction  that  comes  from  a 
constant  sojourn  with  the  simple  the  beautiful,  the 
true! 

Another  opportunity  aflforded  us  by  Time  is  the 
opportunity  to  dream.  People  in  general  are  much 
too  ready  to  scoff  at  the  dreamer,  but  the  greatest 
achievements  the  world  has  known  have  been  the 
realization  of  dreams.  Abraham  Lincoln  was  a 
dreamer;  Pasteur  was  a  dreamer,  and  Christ  was 
a  dreamer ;  and  we  have  reason  to  give  thanks  for 
the  dreams  they  dreamt.  At  the  twenty-fifth  anni- 
versary of  the  founding  of  the  Adirondack  Cottage 
Sanatorium,  Dr.  Trudeau  said :  "  I  dreamed  a 
dream  of  a  great  sanatorium  that  should  be  the 
everlasting  foe  of  tuberculosis,  and  lo!  the  dream 
has  come  true."  ^    And  of  what  do  you  dream? — 

* "  The  Beloved  Physician,"  by  Stephen  Chalmers,  page  27. 


THE  SPOILS  OF  WAR  241 

the  gramophone's  rag-time  ?  the  stakes  in  the  jack' 
pot?  the  glitter  and  tinsel  of  life?  Or  do  you 
dream  of  a  something  grand  and  worthy  with  which 
you  will  repay  the  world  for  the  time  you  have 
taken?  Even  if,  as  Stevenson  says,  "  we  come  not 
within  sight  of  the  castle  of  our  dreams,"  there, 
nevertheless,  is  a  valuable  treasure  to  be  found 
underlying  the  mere  act  of  dreaming.  In  India, 
the  Hindoo  child  is  trained  to  give  at  least  one-half 
hour  of  every  day  to  relaxation,  tranquillity,  and 
meditation,  and  in  this  fact  William  James  finds  an 
explanation  of  the  wonderful  self-possession  of 
the  natives. 

As  strength  returns,  there  will  come  an  added 
zest  to  thought.  Dreaming,  that  unguided  drifting 
of  the  mind,  will  voluntarily  take  on  a  pilot  and  by 
reflection  steer  a  definite  course.  You  will  find  in 
the  bivouac  of  battle  an  opportunity  to  unravel 
those  mental  tangles  which  the  stress  of  active  life 
has  left  moldering  in  the  storehouse  of  the  mind. 
You  will  have  the  time  to  gain  a  clear  idea  of  where 
you  stand,  to  find  yourself,  to  acquire  a  degree  of 
self-knowledge  unrealized  before.  The  mind,  like 
a  child,  will  naturally  run  away  from  that  which  is 
serious  and  stern  and  strange,  and  until  the  real 
happiness  that  underlies  serious  thinking  is  discov- 
ered, the  mind  very  often  will  slip  away  to  play 
with  trivialities.  It  is  by  no  means  wise  that  the 
mind  should  ponder  continually  over  that  which 
requires  concentration,  but  the  day  should  never 
pass  without  some  little  corner  of  it,  if  only 
five  minutes,  being  given  up  to  reflection  that  en- 
riches character. 
16 


343  THE  BATTLE  WITH  TUBERCULOSIS 

In  time,  when  the  true  happiness  of  serious 
reflection  is  realized,  there  will  be  a  tendency  more 
and  more  marked  to  get  away  from  the  petty 
thoughts,  which  too  often  are  tainted  with  envy, 
jealousy,  pride  and  prejudice,  and  there  will  come 
a  day  when  you  deliberately  set  out  to  find  topics 
on  which  your  mind  may  feast.  There  will  occur 
to  you  such  questions  as — Why  am  I  living? 
What  is  my  life's  objective?  What  is  goodness? 
What  quality  more  than  any  other  makes  for  hap- 
piness? Where  does  duty  to  self  end  and  selfish- 
ness begin?  What  constitutes  success?  and  the 
like.  Every  phase  of  life  is  suggestive  of  topics, 
but  if  you  have  difficulty  in  finding  them,  secure 
one  of  the  many  excellent  topic  calendars  which 
have  a  worth-while  thought  for  every  day  in  the 
year.  Make  that  thought  the  text  of  your  reflection 
hour,  and  ponder  it  over  until  you  have  its  truth 
never  to  be  forgotten.  A  little  of  this  each  day, 
not  enough  to  tire  you,  and  you  will  surely  see  you 
are  gathering  in  some  spoils  of  war. 

Then  comes  the  opportunity  for  reading.  Is  the 
full  time  of  the  battle  to  be  wasted  on  cheap  novels, 
indifferent  magazines  and  newspapers?  Or  is  a 
little  of  each  day  to  be  devoted  to  the  reading  of 
something  that  is  really  valuable  ?  Think  of  the  op- 
portunity to  learn  through  the  reading  of  biography 
how  other  men  have  lived  and  made  good ;  think 
of  the  opportunity  to  profit,  through  the  reading 
of  history,  by  the  virtues  and  mistakes  of  rulers 
and  governments;  think  of  the  inspiration  and 
power  that  is  yours  for  the  taking  in  the  essays 
and  poems  of  the  great  masters.    Everybody  pro- 


THE  SPOILS  OF  WAR  243 

fesses  to  long  for  an  opportunity  to  gain  these 
things  which  men  know  are  good,  but  when  the 
opportunity  comes,  with  what  bitterness  it  is  re- 
garded! No  man  is  expected  to  enthuse  over  ill- 
ness, or  even  to  welcome  it,  but  what  cannot  be 
cured  must  be  endured,  and  he  who  can  find  in 
misfortune  treasures  which,  when  the  wreck  is 
cleared  away,  will  enable  him  to  meet  the  world  on 
a  higher  plane  than  that  on  which  he  left  It,  may  live 
to  bless  the  blow  that  felled  him.  Thus  we  find 
Dr.  Trudeau  writing :  "  The  struggle  with  tuber- 
culosis has  brought  me  experiences  and  left  me 
recollections  which  I  never  could  have  known  other- 
wise, and  which  I  would  not  exchange  for  the 
wealth  of  the  Indies ! "  2 

Fine  as  are  those  spoils  of  war  which  are  found 
by  diligent  search,  they  are  not  to  be  compared  to 
the  wealth  of  treasure  which  lies  strewn  along  the 
road  of  renunciation.  Not  one  man  In  a  thousand 
would  travel  that  road  from  choice.  Christ  Is  prob- 
ably the  only  man  who  has  travelled  it  absolutely, 
and  so  far  have  men  strayed  from  the  teachings 
of  Christ  that,  in  the  eyes  of  the  world,  achieve- 
ment is  everything,  and  renunciation  is — well,  It 
Is  all  right  for  a  sick  man.  Yes,  it  is  all  right  for 
a  sick  man,  and  if  during  illness  the  sick  man  can 
learn  some  of  the  lessons  renunciation  teaches,  his 
battle  will  not  have  been  fought  in  vain,  "  In  this 
world,"  as  Henry  Ward  Beecher  says,  "  It  is  not 
what  we  take  up  but  what  we  give  up,  that  makes 
us  rich."    This  being  so,  surely  the  man  with  tuber- 

*"An  Autobiography,"  by  E.  L.  Trudeau,  page  317, 


244  THE  BATTLE  WITH  TUBERCULOSIS 

culosis  should  come  out  of  the  conflict  wealthy  in 
spiritual  conquest! 

The  first  treasure  of  renunciation  is  self- 
reverence.  No  matter  how  you  treated  your- 
self before  the  conflict,  once  on  the  battlefield 
you  have  to  begin  to  take  yourself  seriously. 
You  gain  a  more  perfect  valuation  of  the  quali- 
ties within  yourself  which  make  for  strength.  You 
gain  a  more  perfect  perspective  of  yourself  in  rela- 
tion to  the  world,  and  you  gain  a  greater  rever- 
ence for  your  body  itself. 

Then  come  self-knowledge  and  the  knowledge 
of  others.  Napoleon  wrote :  "  When  I  was  happ}', 
I  thought  I  knew  men,  but  it  was  fated  that  I  should 
know  them  in  misfortune  only."  But  valuable 
as  it  is  to  know  who  are  one's  friends,  it  is  in  no 
sense  as  valuable  as  the  knowledge  of  one's  self. 
To  learn  your  limitations,  to  know  what  you  can 
depend  on  yourself  to  do,  and  wherein  you  are 
liable  to  miss  fire :  this  is  knowledge  that  would  save 
many  a  man  from  ruin. 

Above  all,  however,  renunciation  brings  self- 
control.  "  It  is  notorious,"  writes  William  James, 
"that  a  single  successful  effort  of  moral  volition, 
such  as  saying  *  No '  to  some  habitual  temptation, 
or  performing  some  courageous  act,  will  launch  a 
man  on  a  higher  level  of  energy  for  days  and  weeks, 
will  give  him  a  new  range  of  power."  ^  Many  a 
time  must  the  tuberculosis  warrior  say  "  No."  If 
he  does  not  say  it,  and  act  upon  it,  he  loses  his 
battle.  In  this  disease  more  than  in  any  other, 
physical  restoration  is  dependent  on  moral  victory. 

•"Memoirs  and  Studies,"  by  William  James,  page  250. 


THE  SPOILS  OF  WAR  245 

The  reward  of  the  sternly  fought  fight  lies  often  in 

a  return  to  bodily  health,  but  come  life,  come  death, 

the  greatest  gift  to  the  earnest  fighter  is  spiritual 

power. 

"  Self -reverence,  self-knowledge,  self-control, 
These  three  alone  lead  life  to  sovereign  power." 

If  he  who  before  his  illness  was  a  weakling  and 
the  victim  of  his  own  desires  learns  through  re- 
nunciation what  he  must  to  regain  life  and  strength, 
he  may  go  back  to  the  world  a  ruler  of  men,  simply 
because  he  has  conquered  himself.  "  Strength  is 
born  in  the  deep  silence  of  long-suffering  hearts; 
not  amidst  joy." 

But  if  triumphing  over  the  disease  is  not  every- 
thing, and  if  "  the  true  success  is  in  labor,"  how  is 
it  that  the  spoils  of  war  seem  to  be  so  unequally 
divided  ?  How  is  it  that  one  man,  though  tottering 
on  the  brink  of  the  grave,  has  found  in  the  priva- 
tion of  illness  many  of  the  most  beautiful  attributes 
of  character;  while  another,  to  whom  life  would 
seem  to  offer  much  more  in  comparison,  has  found 
in  the  struggle  little  but  disappointment,  sorrow, 
and  bitterness?  To  understand  fully  you  must 
know  the  two  men,  and  find  out  from  the  actions 
of  each  what  it  is  each  strives  after.  You  will  find 
of  the  one  that  his  greatest  object  in  life  is  to  find 
happiness  for  others.  His  greatest  concern  is  that 
his  fellow-patients,  the  nurses,  the  doctors,  every- 
body with  whom  he  comes  in  contact,  shall  receive 
something  from  him  that  will  be  helpful  and  make 
them  happy.  The  long  hours  of  rest,  the  giving  up 
of  good  times,  and  the  strict  discipline  of  the  battle, 
are  not  a  burden,  because  he  is  making  each  sacri- 


246  THE  BATTLE  WITH  TUBERCULOSIS 

fice,  not  for  himself,  but  for  the  loved  ones  at 
home,  and  to  do  it  for  them  is  a  privilege,  not  a 
privation.  The  more  he  strives,  the  greater  is  his 
measure  of  success;  the  more  happiness  he  gives 
to  others,  the  greater  is  the  happiness  which  comes 
to  him.  His  illness  has  afforded  him  unusual  op- 
portunities for  thinking  of  others ;  and  so  he  looks 
back  upon  his  illness  with  strange  inward  peace. 

The  second  man,  on  the  other  hand,  has  for  his 
greatest  object  in  life  the  securing  of  happiness  for 
himself.  He  likes  or  dislikes  his  fellow  patients,  the 
nurses,  the  doctors,  everybody  with  whom  he  comes 
in  contact,  just  in  proportion  to  the  amount  of  hap- 
piness which  they  bring  him.  The  long  hours  of 
rest  and  strict  discipline  of  the  battle  are  as  gall 
and  wormwood  to  him,  because  they  represent  just 
so  much  good  time  thrown  away,  that  he  might 
have  spent  in  following  his  own  desires.  There  is 
nothing  but  bitterness  to  him  in  renunciation,  be- 
cause in  every  act  of  giving  up  there  is  something 
of  what  he  holds  most  dear  that  has  to  be  sacrificed. 
He  thinks  continually  of  what  he  wants — every 
hour  of  every  day  is  filled  with  fear  that  he  will  not 
get  it.  He  thinks  also  of  what  he  does  not  want,  of 
what  people  think  of  him,  of  what  respect  and  kind- 
ness people  ought  to  show  him.  Can  aught  but 
disappointment,  discontent,  sorrow,  and  bitterness 
be  the  lot  of  such  an  objective  in  life  ? 

From  out  the  fourteenth  century  come,  yet  again, 
the  immortal  words  of  Thomas  a  Kempis :  "  Know 
that  the  love  of  thyself  doth  hurt  thee  more  than 
anything  in  the  world.  .  .  .  H  thou  seekest 
this  or  that,  and  wouldst  be  here  or  there  to  enjoy 


THE  SPOILS  OF  WAR  247 

thy  own  will  and  pleasure,  thou  shalt  never  be  quiet 
nor  free  from  care:  for  in  everything  somewhat 
will  be  wanting,  and  in  every  place  there  will  be 
some  that  will  cross  thee.  .  .  On  this  sin,  that 
a  man  inordinately  loveth  himself,  almost  all  de- 
pendeth,  whatsoever  is  thoroughly  to  be  overcome ; 
which  evil  being  once  overcome  and  subdued,  there 
will  presently  ensue  great  peace  and  tranquillity.  It 
is  but  little  thou  sufferest  in  comparison  of  them 
that  have  suffered  so  much,  were  so  strongly 
tempted,  so  grievously  afflicted,  so  many  ways  tried 
and  exercised.  Thou  oughtest  therefore  to  call  to 
mind  the  more  heavy  sufferings  of  others,  that  thou 
mayest  the  easier  bear  thy  little  adversities.  And 
if  they  seem  not  little  unto  thee,  beware  lest  thy 
impatience  be  the  cause  thereof.  .  .  I  have 
often  said  unto  thee  and  now  again  I  say  the  same. 
Forsake  thyself,  resign  thyself,  and  thou  shalt  en- 
joy much  inward  peace.  .  .  Then  shall  all  vain 
imaginations,  evil  perturbations,  and  superfluous 
cares  fly  away,  then  shall  immoderate  fear  leave 
thee,  and  inordinate  love  shall  die," 


APPENDIX 

DISINFECTANTS 

Carbolic  acid,  formalin  and  corrosive  sublimate 
act  very  slowly  in  killing  bacilli  in  moist  sputum 
because  they  "  coagulate  "  or  clot  the  outer  layers 
of  sputum  and  so  wall  off  the  inside  parts  from  the 
action  of  the  disinfectant.  Thus  5  per  cent,  car- 
bolic acid  requires  at  least  twenty-four  hours  to  be 
effective,  even  in  smears  of  sputum. 

Those  disinfectants  which  dissolve  the  sputum 
are  best.  Lysol  in  2  per  cent,  solution  for  gen- 
eral purposes,  and  calcium  chloride  (chlorinated 
lime)  for  spittoons,  chambers,  and  other  receptacles 
containing  infected  excretions,  are  best.  A  2  per 
cent,  lysol  solution  should  always  be  on  hand,  and 
is  made  by  adding  to  two  and  a  half  pints  of  water 
one  ounce  or  two  tablespoonfuls  of  pure  lysol. 
Chlorinated  lime  is  sold  in  powder  form  in  tins 
with  p>erforated  tops,  and  is  either  dusted  on  the 
excretions  or  used  in  2  per  cent,  solution  (about 
one  ounce  to  a  quart  of  water). 

DISPOSAL   OF   SPUTUM 

The  regular  sputum  box  filler  should  never  Be 
allowed  to  contain  more  sputum  than  fills  the  lov/er 
half  up  to  the  small  square  opening.  When  this 
limit  has  been  nearly  reached,  sawdust  should  be 
added  to  a  level  with  the  top  of  the  box.  The 
filler  is  thuen  removed  from  the  tin  box  holder  and 
«48 


APPENDIX  249 

wrapped  in  several  plies  of  newspaper,  the  more  the 
better,  and  securely  tied.  The  parcel  thus  formed 
is  placed  in  a  bed  of  red  hot  coals. 

Disinfection  of  sputum  by  boiling  is  dirty  and 
unsatisfactory.  If  for  any  reason  sputum  cannot 
be  destroyed  by  burning,  it  must  be  thoroughly  dis- 
infected by  being  treated  with  an  equal  quantity 
of  2  per  cent,  solution  of  chlorinated  lime  before 
being  disposed  of  in  any  other  way. 

The  tin  sputum  cup  holder  should  be  boiled  before 
a  new  filler  is  inserted. 

ACCIDENTS  WITH  SPUTUM 

When  sputum  falls  on  the  floor,  it  should  be 
soaked  into  and  wiped  up  with  absorbent  cotton 
which  is  wrapped  in  a  newspaper  and  burnt.  A 
2  per  cent,  solution  of  either  lysol  or  chlorinated 
lime  should  be  poured  on  the  area  of  floor  contami- 
nated, and  allowed  to  soak  for  at  least  an  hour 
before  being  wiped  up. 

DISINFECTION  OF  CLOTHING 

Smears  of  sputum  on  clothing,  bedclothes  of 
other  places  should  be  attended  to  immediately 
after  they  are  discovered,  by  wiping  with  old  pieces 
of  cotton,  soaked  in  a  2  per  cent,  solution  of  lysol. 
The  pieces  of  cotton  should  later  be  burned.  After 
disinfecting  with  the  lysol,  the  smeared  article 
should  be  placed  in  the  direct  rays  of  the  sun,  for  at 
least  six  hours,  in  order  to  disinfect  other  possibly 
infected  areas  not  covered  by  the  lysol.  For  further 
and  more  thorough  disinfection,  fumigation  is 
necessary. 


^ 


APPENDIX 


DISINFECTION  OF  THE  HANDS 


For  general  purposes  and  habitual  use,  a  good 
brand  of  carbolic  soap  and  hot  water  is  all  that  is 
necessary.  Where,  however,  the  hands  become 
contaminated  with  visible  sputum,  it  is  well  to  soak 
them  for  a  minute  or  two  in  a  i  per  cent,  lysol 
solution  after  washing  them.  Before  drying,  they 
should  be  thoroughly  rinsed  in  clean  water. 

CARE  OF  TOOTH-BRUSH 

Unless  a  tooth-brush  is  occasionally  disinfected 
it  becomes  a  harborer  of  many  varieties  of  germs. 
An  occasional  boiling,  or  a  soaking  of  it  for  twenty- 
four  hours  in  some  disinfectant,  is  of  advantage. 
The  ideal  scheme,  however,  is  to  have  a  long  glass 
bottle  with  a  perforated  partition  raised  one  inch 
from  the  bottom.  To  a  depth  of  one-half  an  inch 
from  the  bottom  is  placed  undiluted  (commercial) 
formalin,  the  fumes  of  which  fill  the  bottle  and 
create  an  antiseptic  environment  for  the  brush. 
The  bottle,  of  course,  must  be  kept  corked,  and  the 
brush  should  be  rinsed  carefully  before  using. 

MOUTH  WASH  AND  THROAT  GARGLE 

Ordinary  baking  soda  (soda  bicarbonate),  one- 
half  teaspoonful  to  a  third  of  a  tumbler  of  warm 
water,  is  good  for  general  and  habitual  use  as  a 
gargle.  Used  regularly  three  times  a  day  before 
meals,  it  is  a  preventive  of  colds  and  other 
infections. 

DISINFECTION  OF  DISHES  AND  EATING  UTENSILS 

To  disinfect  dishes  satisfactorily,  there  is  re- 
quired an  ordinary  dish-pan  or  pot,  fitted  with  a 


APPENDIX  2$t 

wire-netting  basket  or  a  perforated  steamer  which 
supports  the  dishes  from  resting  on  the  base  of  the 
dish-pan.  The  supporting  basket  prevents  the 
dishes  from  cracking,  as  is  liable  to  happen  when 
they  come  in  direct  contact  with  the  bottom  of  the 
heated  pan.  Also  it  affords  an  easy  means  of  lift- 
ing the  dishes  out  of  the  boiling  water  after  they 
are  sterilized.  When  the  pan  is  properly  covered, 
five  minutes' actual  boiling  will  render  the  dishes  and 
utensils  perfectly  safe  for  all  practical  purposes. 

DISINFECTION  OF  SMALL  ARTICLES 

To  disinfect  small  articles,  such  as  a  valise  or 
dress-suit  case,  which  have  no  apparent  smears  of 
sputum,  it  is  sufficient  to  wipe  them  over  with  a  2 
per  cent,  solution  of  lysol  and  then  place  them  in 
the  direct  rays  of  the  sun  for  six  hours. 

LAUNDRY 

Soiled  linen,  particularly  handkerchiefs,  should 
be  handled  as  little  as  jxDssible,  and,  where  feasible, 
should  be  placed  in  the  laundry  bag  by  the  patient 
himself.  When  the  laundry  is  done  at  home,  hand- 
kerchiefs, at  least,  should  be  soaked  in  a  2  per  cent, 
solution  of  lysol  for  twenty-four  hours  before 
washing. 

DISINFECTION    OF    MOPS   AND    DUSTERS 

Boil  for  ten  minutes  or  soak  over  night  in  a  2 
per  cent,  solution  of  either  lysol  or  chlorinated 
lime. 

FUMIGATION 

For  each  one  thousand  cubic  feet  of  space  in  the 
box  or  room  to  be  fumigated,  at  least  eight  ounces 


252  APPENDIX 

of  the  commercial  (40  per  cent.)  formalin  should 
be  mixed  with  one  pound  of  lime  and  two  and  a 
half  to  three  ounces  commercial  sulphuric  acid. 
The  formalin  is  placed  in  a  water  pitcher  with  half 
as  much  water.  The  sulphuric  acid  is  added  slowly. 
The  lime  is  placed  in  a  china  or  earthenware  basin 
resting  on  several  plies  of  newspaper  on  the  floor. 
As  soon  as  the  fluid  is  poured  on  the  lime,  fumes 
are  liberated  and  are  very  dangerous  if  inhaled. 
Consequently,  everything  must  be  in  readiness  for 
an  immediate  exit  and  fastening  of  the  door  as 
soon  as  the  lime  and  fluid  are  mixed.  If  possible, 
an  experienced  man  should  be  employed  for  all 
fumigation  that  is  extensive.  The  fumes  should 
not  be  liberated  under  six  hours  at  least,  and 
eighteen  hours  gives  the  best  results. 

DISINFECTION  OF  MATTRESSES,  PILLOWS, 
BEDCLOTHES,  ETC. 

Fumigation  will  not  destroy  the  tubercle  germs 
in  a  visible  smear  of  sputum.  Consequently,  all 
smears  must  be  treated  as  in  disinfection  of  clothes 
before  the  articles  are  placed  in  a  fumigation  box 
or  a  room  which  is  being  fumigated. 

DISINFECTION  OF  ROOMS  AND  HOUSES 

All  smears  of  sputum  should  first  be  treated  as 
described  under  the  heading  "  Disinfection  of 
Clothing."  The  doors  of  cupboards  and  the 
drawers  of  bureaus  should  be  opened,  mattresses 
should  be  stood  on  edge  or  hung  over  clotheslines 
suspended  for  the  purpose.  Clothes  should  be  hung 
up  where  the  fumes  may  envelop  them.    All  water 


APPENDIX  253 

should  be  removed  from  the  room.  Strips  of  glue 
paper  (sold  for  the  purpose)  should  be  pasted  over 
all  cracks  in  the  windows  and  doors,  keyholes,  etc. 
The  materials  in  right  proportion  for  the  space  of 
the  room  should  be  used,  as  under  the  heading 
"  Fumigation."  After  fumigation  is  completed,  all 
woodwork  should  be  scrubbed  with  a  hot  solution 
of  soda,  and  where  possible  the  woodwork  should 
be  repainted  and  the  walls  rekalsomined  or 
repapered. 

PASTEURIZATION   OF    MILK 

To  pasteurize  milk,  it  is  placed  in  a  closed  vessel, 
or  constantly  stirred,  while  it  is  raised  to  a  tem- 
perature of  150°  F.  (65°  C.)  and  maintained  at 
such  temperature  for  twenty  minutes.  Regular 
pasteurizers  are  on  the  market,  but  some  home  im- 
provisations are  satisfactory. 

Unless  the  milk  is  going  to  be  used  immediately 
after  pasteurization,  it  should  be  placed  in  the  ice 
box  and  rapidly  cooled. 

BEEF-JUICE  PREPARATION 

Fresh,  lean  beef  of  the  cheapest  and  toughest  cuts, 
such  as  brisket  or  rump,  should  be  heated  super- 
ficially in  a  dry  saucepan  until  of  a  gray  color  on 
the  outside.  The  meat  is  then  placed  ifi  a  meat  press 
(sold  at  most  hardware  stores)  and  the  juice  ex- 
pressed. If  it  be  difficult  to  bring  pressure  to  bear, 
a  piece  of  iron  piping  may  be  used  on  the  handle  of 
the  meat-press  to  afford  additional  leverage. 


INDEX 


Acute  tuberculosis,  40 

Adhesion,  44 

Air,  regulation  of,  61 

Alcoholic  beverages,  140 

Altitude  in  relation  to 
hemorrhage,  iiS;  in  re- 
lation to  tuberculosis,  113, 
118 

Animals,  effects  of  toxin  on, 
176;  tuberculosis  in,  15 

Antibodies  in  tuberculosis, 
16 

Anti-tuberculosis  workers, 
results  achieved  by,  108 

Apparent  cure  of  tubercu- 
losis, 229 

Arrest  of  tuberculosis,  230 

Auto-suggestion,  226 

6 

Bacillus  tuberculosis,  de- 
scription of,  15;  distribu- 
tion of,  15;  immunity  to 
mechanism  of,  176;  modes 
of  entry  and  distribution, 
21,  26;  modes  of  entry  and 
distribution  in  bowel,  45 ; 
in  lungs,  23,  29 ;  in  throat, 
45;  number  of,  149;  secon- 
dary auto-infection  by, 
45;  varieties  of,  15 

Baths,  cold,  199 

Beef  juice,   preparation   of, 

253        .       . 

Blood-poisoning,  process  of, 
21 

Boarding-houses,  disadvan- 
tages of,  119 

Bowels,  regulation  of,  144 


Calcification,  mechanism  of, 

36 
"  Catching  cold,"  causes  and 

prevention  of,  197 
Cavity,  process  of  formation, 

41 


Change,  advantages  of,  loi, 
129;  disadvantages  of,  119 

Change  in  altitude,  118,  233 

Chart,  keeping  of,  148 

Chilblains,   155 

Chills,   194 

Christian  Science,  221 

Chronic  tuberculosis,  40 

Cilia,  action  of,  23 

Classification  of  forms  of 
tuberculosis,  38 

Climate  in  relation  to 
healthy  people,  59;  in  re- 
lation to  tubercular  peo- 
ple,  III 

"  Color,"  treatment  of,  202 

Complications,  197 ;  bowel 
involvement,  205 ;  cold 
abscess  and  fistula,  205 ; 
congestion,  199;  hemor- 
rhage, 202;  indigestion, 
204 ;  insomnia,  205 ;  laryn- 
gitis, 200;  secondary  in- 
fections, 197 ;  softening, 
206 

Congestion,  199 

Constipation,  144 

Cough,  188;  emetic,  189; 
regulation  of,  151 

Course  of  tuberculosis,  194 

Cultures  of  germs,  175 

"  Cures  "  for  tuberculosis, 
91,  207 

D 

Death,  232 

Decrease  of  tuberculosis,  108 

Delayed,  reaction,  191 

Diagnosis  of  tuberculosis, 
73-81 ;  cold  abscess  in,  80 ; 
cough  in,  78;  difficulties 
for  doctor  in,  87;  fatigue 
in,  T>, ;  fever  in,  76 ;  hered- 
ity in,  80;  indigestion  in, 
79;  loss  of  voice  in,  "JT, 
pain  or  pleurisy  in,  79; 
physical  examination  in, 
94;^  spitting  blood  in,  ^^', 
weight  in,  78 

Diarrhoea,  205 

25s 


256 


INDEX 


Diet  in  tuberculosis,  136; 
beef-juice,  138;  prepara- 
tion of  beef -juice,  253; 
eggs,  137;  fats  and  oils, 
138;  fluids,  140;  meats, 
137;  milk,  136;  vegetables 
and  carbohydrates,  139 

Digestion,  mechanism  of, 
158 

Discrimination  among  pa- 
tients, 49 

Dishes,  control  of,  152;  dis- 
infection of,  250 

Disinfectants,  248 

Disinfection,  of  clothing, 
249;  of  dishes  and  eating 
utensils,  250;  by  fumiga- 
tion, 251;  of  hands,  250; 
of  houses,  51,  252;  of 
mattresses  and  bedding; 
252;  of  mops  and  dusters, 
251;  of  rooms,  252;  of 
small  articles,^  251 

Diversions  for  sick  patients, 

239 

Doctors,  advertising  by,  91 ; 
consultation  among,  95 ; 
importance  of,  in  new  lo- 
cations, 120 ;  relation  of 
patient  to,  84,  88,  93,  128; 
types  of,  90 

Dulness,  35 

Duration  of  tuberculosis^ 
228 

Dust,  entrance  of,  to  lungs, 
23 ;  in  occupation,  62 ; 
regulation  of,  in  house, 
153 


Emaciation,    187 

Excitement,  _  effect  of,  on 
tuberculosis,  191,  215 

Exercise,  definition  of,  181 ; 
effect  of,  on  body,  159; 
passive,  182 ;  pulmonary, 
183 ;  tuberculin  liberated 
during,  180;  value  of,  181 

Expectoration  (see  Sputum) 

Fear,  effect  of,  213;  in 
tuberculosis,  219 


Fever,  190;  cause  of,  164; 
feelings  as  related  to,  148 

Fibrosis,  process  of  forma- 
tion, 36 

Financial  problem  in  tuber- 
culosis, 108,  115 

Fistula  in  ano,  205 

Food,  contamination  of,  53 ; 
regulation  of,  with  chil- 
dren, 52;  (see  also  Diet) 

Fumigation,  251 


Galloping   consumption,   39 

Gargle,  250 

George    Sand's   letter,   85 

Germ  theory,  175 

Germs,    distribution    of,    11 

Gland  infection,  27,  38 

H 

Health-resort,  choice  of,  116 
Heart,  action  of,  in  tuber- 
culosis, 163 
Hemorrhage,  42;  cause  and 
treatment    of,    202;    fre- 
quency of,  43 
Heredity,  effects  of,  29 
Hesitating  progression,  232 
Home  treatments,  127;  best 
locality  for,  128 ;  diet,  136 ; 
difficulties  of,  99;  general 
equipment,  132 ;  the  house, 
130;   the  patient's   porch, 
131 ;    the   patient's    room, 
131 ;   personal   equipment, 

133 

Honeycombing,  41 

Hygiene,   general,   51 ;   per- 
sonal, of  patient,  152 


Immunity,    27 ;    mechanism 

of,   176 
Incipient  tuberculosis,  38 
Indigestion,   159,  204 
Infection       with       tubercle 
bacilli,  aids  to,  24;  of  ani- 
mals,  16;  of  bowel,  IS3» 


INDEX 


257 


205;  of  children,  25;  dan- 
gers   of,    in    home,    50; 
dangers  of,  in  sanatoria, 
106;    indirect,    of    lungs, 
22,  32;  through  marriage, 
236;   paths   and   distribu- 
tion of,  21,  26,  33;  by  pets, 
152;    in    schools,    53;    of 
throat,  45,  200 
Insommia,  205 
Intestinal   tuberculosis,    205 
Ischiorectal  abscess,  205 


Lar3mgeal  infection,  45,  200 
Laundry,  251 
Letter-writing,  215 
Lungs,  in  health  and  disease. 

Lymphatic  glands,  infection 

of,  27,  38 
Lymphatic  systemi  20 

M 

Marriage,  235 

Meals,  regulation  of,  141 

Medical  examination,  char- 
acter of,  94;  of  members 
of  patient's  family,  94, 
107;  routine,  94 

Medical  profession,  relation 
of  patient  to,  84 

Mental  effects  in  tubercu- 
losis, 210 ;  auto-suggestion, 
226;  emotion,  211 ;  prayer, 
226 ;  subconscious 
thoughts,  219;  thoughts 
relating  to  sex,  215;  voli- 
tional thoughts,  213 ; 
worry,    220 

Mixed  infections,  15,  40,  184 

Mortality  from  tuberculosis, 
29 

Mouth-breathing,  23,  58,  198 

Mouth-wash,  250 

N 

Night  sweats,  193 
Nurse  and  nursing,  153 

17 


Occupation    in    relation    to 

tuberculosis,  62 
Onset  of  tuberculosis,  ^z 
Optimism    in    tuberculosis, 

173 

P 

Pasteurization  of  milk,  253 

Pasteur's  experiment  to 
show  presence  of  germs, 
12 

Patent  medicines,  83,  207 

Percussion,  35 

Phthisiophobia,  47 

Physical  signs,  35 

Pleura,  43 

Pleurisy,   43 

Pneumothorax,  artificial,  185 

Post-mortem  appearance  of 
lung,  Z7 

Prayer,  226 

Predisposition  to  tubercu- 
losis, 29,  55;  natural 
periods  of,  58;  through 
other  diseases,  57 

Pregnancy  in  tuberculosis, 
236 

Prevention  of  tuberculosis, 
47-73 ;  among  children,  53, 
56;  fresh  air  in  relation 
to,  60;  in  home,  50;  loca- 
tion in  relation  to,  59; 
occupation  in  relation  to, 
62;  recreation  in  relation 
to,  70;  at  school,  53 

Pulse  in  tuberculosis,  148, 
190 


Rales,  36 

Recreation  in  tuberculosis, 
233-  235 

Red  cells,  work  of,  161 

Reflection,  242 

Relapse,   228 

Renunciation,   243 

Resistance,  alcohol  in  rela- 
tion to,  140 ;  altitude  in  re- 
lation to,  59;  balance  in 
relation    to,    68;    climate 


25d 


INDEX 


in  relation  to,  59;  fresh 
air  in  relation  to,  60,  68; 
how  to  develop,  59; 
"  hustling  "  in  relation  to, 
66 ;  location  in  relation  to, 
59 ;  marriage  in  relation 
to,  70;  morality  in  rela- 
tion to,  69 ;  occupation  in 
relation  to,  62;  regularity 
in  relation  to,  66;  system 
in  relation  to,  66;  what 
constitutes,  18 

Resolutions,  how  to  keep, 
170 

Rest,  definition  of,  146;  im- 
portance of,  to  white  cells, 

145 

Results  in  tuberculosis,  228 ; 
classification  of,  230 

Rewards  in  tuberculosis,  238 

Rules  for  self-government, 
172 

Sanatorium,  after  leaving, 
234;  compared  to  home, 
103;  description  of,  117; 
education  in,  104;  life  in, 
loi,  124;  possibility  of  in- 
fection in,  106;  pro- 
gramme of,  123;  results 
of  treatment  at,  228 ;  selec- 
tion of,  no,  117 

Sanitation,  importance  of,  in 
tuberculosis,  129 

Secondary,  infection,  at 
home,  198;  at  sanatorium. 

Self-control,  167,  244;  self- 
training  in,  168 
Self-deception,  83,  231 
Serum,  preparation  of,   178 
Sexual    excess    in   tubercu- 
losis, 215 
Sleep,  regulation  of,  155 
Smoking,  201 
Softening,  40,  206 
Spitting  of  blood,  202 
Sputum,  accidents  with,  249 ; 
control     of,    48;     danger 
from,  53 ;  disposal  of,  248 ; 
management  of,  151;  ori- 
gin of,  34 


Starling's  experiments,  165 
Sunlight,  as  disinfectant,  18 
Sweats,    193 

Symptoms     and     signs     of 
tuberculosis,   73 


Temperature,  taking  of,  147 
(see  also  Fever)  ;  discon- 
tinuing the  taking  of,  234 
Termination  of  tuberculosis, 

228 
Throat,  infection  of,  45,  200 
Tobacco,   use   of,   201 
Tooth-brush,  care  of,  250 
Toxin,  effects  of,   176 
Transmission     of     tubercu- 
losis, 149 
Travelling,  arrangements  be- 
forehand,   117;    arrange- 
ments during,  121 
Trudeau's   experiment  with 

rabbits,  129 
Tubercle  bacillus  (see  Bacil- 
lus tuberculosis) 
Tubercle,  description  of,  34 
Tuberculin,     administration 
of,  168;  character  of,  178; 
reaction,  31 ;  value  of,  179 


Vaccine,  preparation  of,  178; 
autogenous,  184 ;  results 
from,  185;  use  of,  184 

Visits  and  visitors,  155 

W 

Water,  use  of,  in  tubercu- 
losis,  140 

Weight,  in  tuberculosis,  187; 
mechanism  of  adding,  160 ; 
in  diagnosis,  77 

White  cells,  description  of, 
19;  distribution  of,  30 ; 
work  of,   157,  164 

Work,  return  to,  233 

Worry,  220 


Date  Due 

MAR  ( 

)  4  19/9 

M^tiv^ 

i^i^%ffV 

T^Hr 

1  4  »' Lw  U 

PRINTED  IN  u.a.A.            CAT.   NO.   24    161               S^ 

UC  SOUTHERN  REGIONAL  LIBRARY  FACILITY  ) 


A  000  511  126  5 


WF310 
K52b 

1917 
King,  Dougall  MacDougall, 

The  battle  with  tuberculosis 
and  how  to  win  it 


WF310 
K52b 

1917 
King,  Dougall  MacDougedl. 

The  battle  with  tuberculosis  and 
how  to  win  it. 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE.  CALIFORNIA  92664 


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